Íñigo RCA, Torres GLG, Hernández HS, Gómez VJR

Language: Spanish
References: 19
Page: 461-467
PDF size: 255.47 Kb.

ABSTRACT

Background: The Ebstein´s anomaly is a congenital malformation of the tricuspid valve and of the right ventricle that usually is associated with interauricular communication, foramen oval, and arrhythmias of Wolff-Parkinson-White syndrome type.
Objective: To analyze the association between Ebstein´s anomaly and pregnancy.
Patients and methods: A prospective study was made in five pregnant women’s with Ebstein´s anomaly without surgery. We analyzed the clinical history, physical examination, electrocardiogram, x-ray of thorax, Doppler color heart ultrasound, and fetal valoration by means of pelvic ecosonogram and cardiotocographic registry, and routinely prenatal paraclinic tests.
Results: We observed severe expansion of the ventricle and 3^rd degree index of atrialization in two patients. In two pregnancies there were interatrial communication (patients with cyanosis) and in three was detected severe tricuspid insufficiency. The average of gestacional age was of 36.4 ± 1.8 weeks. Two of the five pregnancies has preterm birth. Only one childbirth was short weight to gestational age. The rest stayed within percentile 10. There were no obits or neonatal deaths, either congenital abnormality by Doppler heart ultrasound.
Conclusions: The pregnancy is well tolerated in patients with Ebstein´s anomaly; nevertheless, participation of multidisciplinary team is recommended to establish the treatment.

REFERENCES

1. Attenhofer JCH, Connolly HD, Dearani JA, Edwards WD, Danielson GH. Ebstein´s anomaly. Circulation 2007;115:277-85.

2. Connolly HM, Warnes CA. Ebstein´s anomaly: Outcome of pregnancy. J Am Coll Cardiol 1994;23:1194-8.

3. Elkayam U, Gleicher N. Cardiac problems in pregnancy. 2nd ed. New York: Wiley-Liss, 1990;pp:89-90.

4. Attie F. Cardiopatías congénitas en el adulto. 2a ed. Madrid: Elsevier, 2003;pp:183-9.

5. Celermajer DS, Bull C, Hill JA, Cullen S, et al. Ebstein´s anomaly: presentation and outcome from fetus to adult. J Am Coll Cardiol 1994;23:170-6.

6. Masani ND. Transesophageal echocardiography in adult congenital heart disease. Heart 2001;86(Suppl II):1-22.

7. Attie F, Rosas M, Rijlaarsdam M, Buendia A, et al. The adult patient with Ebstein´s anomaly: outcome in 72 unoperated patients. Medicine 2000;79:27-36.

8. Donnelly JE, Brown JM, Radford DJ. Pregnancy outcome and Ebstein´s anomaly. Br Heart J 1991;66:368-71.

9. González MI, Armada RA, Díaz RJ, Gallego GV y col. Guías de práctica clínica de la Sociedad Española de Cardiología en la gestante con cardiopatía. Rev Esp Cardiol 2000;53:1474-95.

10. Koos BJ. Management of uncorrected, palliated, and repaired cyanotic congenital heart disease in pregnancy. Prog Pediatr Cardiol 2004;19:25-45.

11. Montes FR, Riaño D. Manejo anestésico de paciente obstétrica con anomalía de Ebstein. Rev Colombiana Anestesiol 2004;32:285-7.

12. Groves ER, Groves JB. Epidural analgesia for labour in a patient with Ebstein´s anomaly. Can J Anaesth 1995;42:77-79.

13. Waickman LA, Skorton DJ, Varner MW, Ehmke DA, Goplerud CP. Ebstein´s anomaly and pregnancy. Am J Cardiol 1984;53:357-8.

14. Linter SPK, Clarke K. Caesarean section under extradural analgesia in a patient with Ebstein´s anomaly. Br J Anaesth 1984;56:203-5.

15. Brickner ME, Hillis LD, Lange RA. Medical progress: congenital heart disease in adults (second of two parts). N Engl J Med 2000;342:334-42.

16. Mendelson MA. Atención perinatal de trastornos maternos crónicos. Clínicas de perinatología. México: McGraw-Hill-Interamericana, 1997;pp:485-500.

17. Drenthen W, Pieper OG, Roos-Hesselink JW, Van Lottum WA, et al. Outcome of pregnancy in women with congenital heart disease. J Am Coll Cardiol 2007;49:2303-11.

18. Cabral CF, Karchmer KS, Aguilera PR, Villarreal ME, Ruiz AJ. Perspectiva perinatal de la cardiopatía y embarazo. Revisión de 1,169 embarazos. Ginecol Obstet Mex 1997;65:310-6.

19. Cano LH, Cano AH, Cano AF. Cardiopatía y embarazo. Ginecol Obstet Mex 2006;74:153-7.