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Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Number 02

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Ginecol Obstet Mex 2021; 89 (02)

Pregnancy with maternal congenital heart disease (single ventricle). Case report

Rozo-Rangel A, Monterrosa-Blanco A, Gutiérrez-Aldana L, Acuña-Osorio E, Castro CA

Language: Spanish
References: 20
Page: 167-175
PDF size: 213.30 Kb.


ABSTRACT

Background: Of every 10,000 newborns there are approximately 4 to 8 cases of structural heart malformation of the single ventricle type. If an adequate balance between systemic and pulmonary circulation is achieved, it is possible to live up to 70 years of age. Pregnancy in patients with this condition can aggravate and decompensate heart disease. There are scales to classify, before conception and during pregnancy, the risk of morbidity-mortality.
Objective: To report the case of complex congenital heart disease and the maternal and fetal outcomes.
Clinical case: 37-year-old female patient, with a history of the single left ventricle, pregnant 13 times, with 4 cesarean sections and 9 abortions. She was admitted to the high-risk obstetric service at 11.1 weeks of pregnancy for maternal and fetal surveillance. She was counseled about the possible risks derived from pregnancy and her cardiac disease; however, she decided to carry the pregnancy to term. During pregnancy, preserved ejection fraction with deterioration in functional class repeated desaturation, and placental accreta were documented. The pregnancy was terminated at 32.5 weeks and the postoperative course was without major maternal or fetal complications. The newborn remained in intensive care for two months and six months after delivery, the patient had an episode of heart failure decompensation.
Conclusions: Potential adverse maternal and fetal outcomes in the setting of complex congenital heart disease can be attenuated with early detection of poor prognostic factors and appropriate preconception counseling.


REFERENCES

  1. O’Leary PW. Prevalence, clinical presentation and natural history of patients with single ventricle. Progress in Pediatric Cardiology 2002; 16 (1): 31-8. https://doi.org/10.1016/ S1058-9813(02)00042-5.

  2. Hauck A, Porta N, Lestrud S, Berger S. The Pulmonary Circulation in the Single Ventricle Patient. Children (Basel) 2017; 4 (8): 71. https://doi.org/10.3390/children4080071.

  3. Poterucha JT, Anavekar NS, Egbe AC, Julsrud PR, Connolly HM, Ammash NM, et al. Survival and outcomes of patients with unoperated single ventricle. Heart 2016; 102 (3): 216-22. http://dx.doi.org/10.1136/heartjnl-2015-308440.

  4. Khairy P, Poirier N, Mercier LA. Univentricular Heart. Circulation 2007; 115 (6): 800-12. https://doi.org/10.1161/ circulationaha.105.592378.

  5. Buckland R, Pickett JA. Pregnancy and the univentricular heart: case report and literature review. Int J Obstet Anesth 2000; 9 (1): 55-63. https://doi.org/10.1054/ ijoa.1999.0341.

  6. Wang K, Luo H, Xin Y, Yu H. Successful pregnancy and delivery in patients with uncorrected single ventricle: Three new cases and literature review. Int J Cardiol 2015; 184: 135-9. https://doi.org/10.1016/j.ijcard.2015.01.052.

  7. Pillutla P, Nguyen T, Markovic D, Canobbio M, Koos BJ, Aboulhosn JA. Cardiovascular and Neonatal Outcomes in Pregnant Women With High-Risk Congenital Heart Disease. Am J Cardiol 2016; 117 (10): 1672-7. doi. 10.1016/j. amjcard.2016.02.045.

  8. Garcia Ropero A, Baskar S, Roos Hesselink JW, Girnius A, Zentner D, Swan L, et al. Pregnancy in Women With a Fontan Circulation: A Systematic Review of the Literature. Circ Cardiovasc Qual Outcomes 2018; 11 (5): e004575. doi. 10.1161/circoutcomes.117.004575.

  9. Múnera-Echeverri AG. Enfermedad cardíaca y embarazo. Revista Colombiana de Cardiología 2018; 25: 49-58. https:// doi.org/10.1016/j.rccar.2017.11.028.

  10. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström- Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). European Heart Journal 2018; 39 (34): 3165-41. doi. 10.1093/eurheartj/ehy340.

  11. Martínez Linares JM, Del Moral Chica MaL, Lujano Arenas A, Rabasco Cruz B. Actualización sobre embarazo y enfermedad cardiovascular. Enferm Cardiol 2015; 22 (66): 54-9. https://www.enfermeriaencardiologia.com/wp-content/ uploads/66_07.pdf.

  12. Avila WS, Ribeiro VM, Rossi EG, Binotto MA, Bortolotto MR, Testa C, et al. Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge. Arquivos Brasileiros de Cardiologia 2019; 113: 1062-9. https://doi. org/10.5935/abc.20190197.

  13. Keepanasseril A, Raj A, Pillai AA, Baghel J, Plakkal N, Satheesh S. Pregnancy outcome in women with an uncorrected single ventricle: A single-centre experience from South India. Obstetric Medicine 2019; 0 (0): 1-5. https:// doi.org/10.1177/1753495X19845822.

  14. Bhatia P, Chhabra S. Physiological and anatomical changes of pregnancy: Implications for anaesthesia. Indian Journal of Anaesthesia 2018; 62 (9): 651-7. doi. 10.4103/ ija.IJA_458_18.

  15. Collins RT, 2nd, Chang D, Sandlin A, Goudie A, Robbins JM. National In-Hospital Outcomes of Pregnancy in Women With Single Ventricle Congenital Heart Disease. Am J Cardiol 2017; 119 (7): 1106-10. doi. 10.1016/j.amjcard. 2016.12.015.

  16. Canobbio MM, Cetta F, Silversides C, Warnes C, Aboulhosn J, Colman J. Pregnancy after Fontan operation: early and late outcomes. J Amer Col Cardiology 2013; 61 (10): E427. doi. 10.1016/S0735-1097(13)60427-1.

  17. Jooste EH, Haft WA, Ames WA, Sherman FS, Vallejo MC. Anesthetic care of parturients with single ventricle physiology. J Clin Anesth 2013; 25 (5): 417-23. doi. 10.1016/j. jclinane.2012.08.003.

  18. Zhang S, Barker P, Botting KJ, Roberts CT, McMillan CM, Mc- Millen IC, et al. Early restriction of placental growth results in placental structural and gene expression changes in late gestation independent of fetal hypoxemia. Physiological Reports 2016; 4 (23): e13049. doi. 10.14814/phy2.13049.

  19. Figueras F, Gratacos E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014; 36 (2): 86-98. doi.10.1159/000357592

  20. Vanegas E, Urrea JK. El embarazo en la mujer con enfermedad cardiaca congénita: enfoque para el cardiólogo. Revista Colombiana de Cardiología. 2009; 16: 170-7. http://www. scielo.org.co/pdf/rcca/v16n4/v16n4a5.pdf.




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