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Influence of pregnancy on cardiac function and hemodynamics in women with Ebstein's anomaly
Miki Kanoh1, Kei Inai1, Tokuko Shinohara1
1Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care, Tokyo Women's Medical University, Tokyo, Japan.
Insights
Pregnancy in women with Ebstein's anomaly is generally safe but requires monitoring. Some patients may experience heart failure or arrhythmias, necessitating cesarean delivery.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Congenital Heart Disease
Background:
- Ebstein's anomaly is a rare congenital heart condition affecting the tricuspid valve.
- Perinatal outcomes and right ventricular function in pregnant women with this anomaly are not well-defined.
Purpose of the Study:
- To examine perinatal outcomes and right ventricular function in women with Ebstein's anomaly before, during, and after pregnancy.
- To identify factors influencing the mode of delivery and maternal cardiac risk.
Main Methods:
- Retrospective analysis of 17 women with Ebstein's anomaly who delivered between 1995 and 2015.
- Monitoring of clinical course, mode of delivery, and hemodynamic parameters throughout pregnancy.
Main Results:
- Eight pregnancies (47%) resulted in elective cesarean section, often due to heart failure or arrhythmias.
- Significant increases in cardiothoracic ratio and tricuspid valve regurgitation pressure gradient were observed during pregnancy.
- New York Heart Association (NYHA) functional class deteriorated in five cases during pregnancy.
Conclusions:
- Pregnancy is relatively safe for women with Ebstein's anomaly, but risks of cyanosis, arrhythmia, and heart failure exist.
- Close clinical and hemodynamic monitoring during pregnancy is crucial for managing maternal cardiac risk.
- Appropriate selection of delivery mode, often cesarean section, is vital for favorable outcomes.
Introduction:
We examined the perinatal outcomes and right ventricular function before pregnancy, during pregnancy, and after delivery in women with Ebstein's anomaly.
Material And Methods:
We retrospectively investigated the clinical course and mode of delivery and monitored hemodynamic parameters throughout pregnancy in 17 women with Ebstein's anomaly who delivered at our institution during the period of 1995-2015.
Results:
Eight women, including nine pregnancies, underwent elective cesarean section, and nine women, including 14 pregnancies, underwent vaginal delivery. Elective cesarean section was performed in cases with significant heart failure or arrhythmias and in the presence of more than two of the following: cardiothoracic ratio ≥60%, moderate or severe tricuspid valve regurgitation, tricuspid valve regurgitation pressure gradient ≥35 mmHg during pregnancy. The cardiothoracic ratio and tricuspid valve regurgitation pressure gradient significantly increased during pregnancy compared with prepregnancy values. The New York Heart Association classification deteriorated from class I to class II or III in five cases during pregnancy.
Conclusions:
Although pregnancy was relatively safe among women with Ebstein's anomaly, some women developed cyanosis, arrhythmia, and heart failure, leading to elective cesarean section. Monitoring clinical and hemodynamic changes throughout pregnancy is advised to minimize maternal cardiac risk and select the appropriate mode of delivery.