Outcomes of Pregnancy in Patients With Prior Right Ventricular Outflow Interventions.

Background The purpose of this study was to compare the incidence of pregnancy-related adverse outcomes ( PRAO ) between patients with versus without hemodynamically significant right ventricle outflow tract ( RVOT) . Methods and Results This was a retrospective cohort study of all pregnant patients with isolated RVOT lesions undergoing evaluation at the Mayo Clinic, 1990 to 2017. Hemodynamic significance was defined as ≥moderate pulmonary/conduit stenosis (≥3 m/s) and/or ≥moderate regurgitation. Patients with concomitant significant left heart disease were excluded. PRAO was defined as cardiovascular, obstetric, and/or neonatal complications occurring during the pregnancy through 6 weeks postpartum. A total of 224 pregnancies in 114 patients with RVOT lesions were identified; 38 pregnancies occurred in 24 patients with hemodynamically significant RVOT . Forty-eight (21%) pregnancies ended in spontaneous abortion. Of the 173 completed pregnancies, median gestational age at delivery was 38 (35-40) weeks and median birth weight 2965 (2065-4122) g. Seven pregnancies (4%) were complicated by cardiovascular events, 14 (8%) by obstetric complications, with adverse neonatal outcomes occurring in 38 (22%). There were no maternal deaths. The incidence of spontaneous abortion and PRAO were similar in both the RVOT and hemodynamically significant RVOT groups. As an isolated condition, Tetralogy of Fallot-pulmonary atresia was associated with spontaneous abortion and neonatal complications. Conclusions The risk of cardiovascular complications was low in patients with isolated RVOT lesions, and hemodynamically significant RVOT lesions were not associated with either cardiovascular complications or PRAO . Further studies are required to explore the factors responsible for PRAO in patients with Tetralogy of Fallot-pulmonary atresia.

Use of mechanical valve prostheses in adults with tetralogy of Fallot.

BACKGROUND: There are limited data about the outcomes mechanical prostheses in adults with tetralogy of Fallot (TOF). The purpose of the study was to describe the incidence of mechanical valve related adverse events (MVRAE), reoperation and all-cause mortality in TOF patients with mechanical valve prostheses. METHODS: We reviewed the MACHD (Mayo Adult Congenital Heart Disease) database and identified all adult TOF patients with mechanical valve prostheses, 1990-2017. MVRAE was defined as valve thrombosis, endocarditis, embolic stroke or major bleeding complications. RESULTS: A total of 44 prostheses were implanted in 29 patients (age 44 ±â€¯13 years; men 18 [62%]), and 10 (36%) patients received multiple mechanical prostheses. The median number of prior sternotomies was 3 (range 2-7). Target intentional normalized ratio (INR) was 2.0-3.0 for patients with isolated mechanical aortic prostheses (n = 12, 41%), 2.5-4.0 for mechanical prostheses in non-aortic positions. There were no surgical deaths, and 10 MVRAE (endocarditis [n = 4], major bleeding complications [n = 5] and valve thrombosis [n = 1]) occurred in 7 (24%) patients during a median follow-up of 11 (5 18) years. The 10-year survival and freedom from reoperation were 87% and 95% respectively. CONCLUSIONS: Surgical mortality and valve thrombosis for mechanical valve prostheses are low presumably due to appropriate patient selection and meticulous anticoagulation. Endocarditis and bleeding complications are major concerns. Further studies are required to determine the appropriate target INR that provides the optimal balance between preventing valve thrombosis and avoiding major bleeding complications mechanical valve prostheses in different positions.