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Pregnancy after mustard repair for transposition of the great arteries
D I Lynch-Salamon1, S S Maze, C A Combs
1Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Ohio.
Background:
Since the introduction of surgical repair procedures, women with complete transposition of the great arteries are surviving into their reproductive years. Only three successful pregnancies in such women have been described previously.
Cases:
Three women with transposition of the great arteries repaired in childhood became pregnant in 1991. Two pregnancies were complicated by failure of the systemic ventricle and one by preterm labor. Labor was managed with antibiotic prophylaxis against endocarditis, clinical hemodynamic assessment, epidural anesthesia, avoidance of maternal expulsive efforts in the second stage, and low forceps delivery. Three healthy infants were delivered vaginally between 34-39 weeks' gestation.
Conclusion:
With close cooperation between the cardiologist and obstetrician, successful pregnancy is possible after surgical repair of transposition of the great arteries. However, failure of the systemic ventricle is common and should be diagnosed and treated promptly.