Outcomes of pregnancy in women with tetralogy of fallot

Gruschen R. Veldtman, Heidi M. Connolly, Martha Grogan, Naser M. Ammash, Carole A. Warnes

Research output: Contribution to journalReview article

143 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)174-180
Number of pages7
JournalJournal of the American College of Cardiology
Volume44
Issue number1
DOIs
StatePublished - Jul 7 2004

Fingerprint

Tetralogy of Fallot
Pregnancy Outcome
Pulmonary Hypertension
Right Ventricular Dysfunction
Pregnancy
Birth Weight
Cardiovascular Pregnancy Complications
Lung
Dilatation
Supraventricular Tachycardia
Stillbirth
Left Ventricular Dysfunction
Spontaneous Abortion
Pulmonary Embolism
Pulmonary Artery
Obstetrics
Heart Failure
Hemodynamics
Mothers

Keywords

  • left ventricle/ventricular
  • LV
  • PA
  • PHT
  • pulmonary artery
  • pulmonary hypertension
  • right ventricle/ventricular
  • RV
  • tetralogy of Fallot
  • TOF

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Outcomes of pregnancy in women with tetralogy of fallot. / Veldtman, Gruschen R.; Connolly, Heidi M.; Grogan, Martha; Ammash, Naser M.; Warnes, Carole A.

In: Journal of the American College of Cardiology, Vol. 44, No. 1, 07.07.2004, p. 174-180.

Research output: Contribution to journalReview article

Veldtman, Gruschen R. ; Connolly, Heidi M. ; Grogan, Martha ; Ammash, Naser M. ; Warnes, Carole A. / Outcomes of pregnancy in women with tetralogy of fallot. In: Journal of the American College of Cardiology. 2004 ; Vol. 44, No. 1. pp. 174-180.
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abstract = "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.",
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