Transcatheter Pulmonary Artery Intervention in Tetralogy of Fallot With Pulmonary Atresia During Pregnancy

While long-term survival for tetralogy of Fallot continues to improve, residual hemodynamic abnormalities are common and increase risk for cardiovascular events during pregnancy.

A young woman with tetralogy of Fallot with pulmonary atresia (TOF/PA) having undergone biventricular repair presented with heart failure symptoms and near-systemic right ventricular (RV) pressure in the setting of an unplanned pregnancy. Given her desire to continue the pregnancy coupled with the significant maternal and neonatal risk, percutaneous intervention was performed, improving RV pressure and facilitating the eventual delivery of a healthy term child.

Though high-risk, percutaneous intervention during pregnancy for complex RV outflow tract/pulmonary artery lesions can be performed safely and effectively.

This case highlights successful percutaneous RV outflow tract/pulmonary artery intervention during pregnancy in a patient with TOF/PA. Multidisciplinary care including adult congenital heart disease, maternal fetal medicine, and cardiac anesthesiology for the pregnant patient with complex congenital heart disease is essential.