Obstetric and perinatal aspects in patients with congenital heart diseases.

ABSTRACT

The benefits of surgical treatment for patients with congenital heart disease in relation to pregnancy are still controversial. We studied 48 pregnant women (mean age = 25 years) with surgically-corrected congenital heart diseases (Group 1). This included 15 cyanotic diseases Fallot's tetralogy (11 cases); Ebstein's anomaly (2 cases); transposition of the great arteries (1 case); and double outlet of the right ventricle (1 case). We compared them to 52 pregnant women (mean age = 26 years) with untreated congenital heart diseases, which included 11 cases of Eisenmenger's syndrome (Group 2). Group 2 showed a higher incidence of maternal death (12 vs. 0 percent; p = 0.01), perinatal mortality (15 vs. 0 percent; p = 0.01) and prematurity (32 vs. 7 percent; p = 0.01). Spontaneous abortion (4 vs. 10 percent), Caesarean deliveries (48 vs. 66 percent) or growth retardation (13 vs. 28 percent) did not present any significant differences between these groups. Surgical treatment in patients with heart diseases is associated with a better maternal and fetal prognosis. Therefore, surgery must be considered when counseling patients with congenital heart diseases.

ABSTRACT

PIP In a prospective study of 100 pregnant Brazilian women with congenital heart diseases, the 48 patients who had undergone corrective surgery an average of 10 years before the index pregnancy (group 1) had substantially better maternal and fetal/neonatal outcomes than the 52 women with no history of surgery (group 2). Group 1 included 16 women with cyanotic diseases and 9 with residual heart lesions. In Group 2, 11 women had Eisenmenger's syndrome. There were 6 maternal deaths (12%) in Group 2 3 related to Eisenmenger's syndrome and 3 in women with aortic or subaortic stenosis, but none in Group 1. There were 2 fetal and 5 neonatal deaths in Group 2, but, again, no such deaths in Group 1. Most maternal and fetal/neonatal deaths were associated with left obstructive involvement and cyanosis. Group 2 also included significantly more cases than Group 1 of low birth weight (38% versus 13%), premature birth (32% versus 7%), and intrauterine growth retardation (28% versus 13%). The highest rates of these adverse outcomes were recorded among infants of mothers with Eisenmenger's syndrome, obstructive involvement, and cyanosis. Residual surgical lesions had no adverse effects on maternal or infant outcomes. Surgery should be considered in patients with correctable heart disease who desire pregnancy. However, pregnancy is not recommended for women with Eisenmenger's syndrome and aortic stenosis.