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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Outcomes of pregnancy in women with tetralogy of fallot

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received May 19, 2003; revised manuscript received October 24, 2003, accepted November 24, 2003.

^* Reprint requests and correspondence: Dr. Heidi M. Connolly, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
connolly.heidi{at}mayo.edu

OBJECTIVES: We sought to determine pregnancy outcomes in patients with tetralogy of Fallot (TOF).

BACKGROUND: Pregnancy outcomes in patients with TOF are incompletely defined.

METHODS: Clinical, hemodynamic, and obstetric data were reviewed for women with TOF and prior pregnancy.

RESULTS: Of 72 respondents, 43 (mean age, 26 years) had 112 pregnancies (range, 1 to 5); 82 pregnancies were successful. Eight women had unrepaired TOF at the time of their 20 successful pregnancies. At first assessment (age 18 years), six patients had pulmonary hypertension, three had moderate or severe right ventricular (RV) systolic dysfunction, and 13 had severe RV dilation due to pulmonic regurgitation. Sixteen patients had 30 miscarriages (27%) and one term stillbirth. Mean overall birth weight was 3.2 kg (range, 2.1 to 4.2 kg). Unrepaired TOF (p = 0.05) and morphologic pulmonary artery abnormality (p = 0.03) were independently predictive of infant birth weight. Six patients had cardiovascular complications during pregnancy: supraventricular tachycardia in two, heart failure in two, pulmonary embolism in a patient with pulmonary hypertension, and progressive RV dilation in a patient with severe pulmonic regurgitation. Five infants (6%) had congenital anomalies.

CONCLUSIONS: Patients with TOF have an increased risk of fetal loss, and their offspring are more likely to have congenital anomalies than offspring in the general population. Adverse maternal events, although rare, may be associated with left ventricular dysfunction, severe pulmonary hypertension, and severe pulmonic regurgitation with RV dysfunction.

Abbreviations and Acronyms   LV = left ventricle/ventricular   PA = pulmonary artery   PHT = pulmonary hypertension   RV = right ventricle/ventricular   TOF = tetralogy of Fallot

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