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J Am Coll Cardiol, 2001; 38:1728-1733 © 2001 by the American College of Cardiology Foundation |
a Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Manuscript received April 2, 2001; revised manuscript received July 12, 2001, accepted August 10, 2001.
* Reprint requests and correspondence: Dr. Heidi M. Connolly, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
OBJECTIVES
The study sought to determine the outcome of pregnancy in women with coarctation of the thoracic aorta.
BACKGROUND
Patients with coarctation of the thoracic aorta are expected to reach childbearing age, but data on the outcome of pregnancy in this population are limited.
METHODS
The Mayo Clinic database was reviewed for women of childbearing age (
16 years old) with a diagnosis of aortic coarctation evaluated from 1980 to 2000. Spectrum of cardiovascular disease, surgical history, and obstetrical and neonatal outcomes were determined.
RESULTS
Fifty women with coarctation had pregnancies: 30 had coarctation repair before pregnancy, 10 had repair after pregnancy, 4 had repair both before and after pregnancy, and 6 had no history of repair. The 50 women had 118 pregnancies resulting in 106 births. There were 11 miscarriages (9%), 4 premature deliveries (3%), and 1 early neonatal death; 38 deliveries (36%) were by cesarean section. Of the 109 offspring, 4 (4%) had congenital heart disease. A patient with Turner syndrome died of a Stanford type A dissection at 36 weeks of pregnancy. Nineteen women (38%) were known to have hemodynamically significant coarctation during pregnancy (gradient 20 mm Hg). Fifteen women (30%) had hypertension during their pregnancy, 11 of whom (73%) had hemodynamically significant coarctation during that time (8 with native and 3 with residual/recurrent coarctation).
CONCLUSIONS
Major cardiovascular complications were infrequent but continue to be a source of concern for patients with coarctation who become pregnant. Systemic hypertension during pregnancy was common and related to the presence of a significant coarctation gradient.
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