Chinami Horiuchi1, Chizuko A Kamiya2, Hideo Ohuchi3, Takekazu Miyoshi4, Mitsuhiro Tsuritani2, Naoko Iwanaga2, Reiko Neki2, Koichiro Niwa5, Kenichi Kurosaki3, Hajime Ichikawa6, Tomoaki Ikeda4, Jun Yoshimatsu2. 1. Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan. Electronic address: chinami@ncvc.go.jp. 2. Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 3. Departments of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 4. Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan. 5. Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan. 6. Departments of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Abstract
OBJECTIVE: Arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA) has gradually replaced the atrial switch operation and has become the standard operation. To date, the outcomes of pregnant women with d-TGA after this new operation have not been investigated. In this study, we investigated the impact of ASO on pregnant outcomes and mid-term prognosis in women with d-TGA and compared with the atrial switch operation through the literature review. METHODS AND RESULTS: There were 20 pregnancies in 10 women with d-TGA after ASO and 6 resulted in abortion. Among 14 successful pregnancies in 10 women, 11 pregnancies achieved the term delivery and 3 pregnancies, including 1 twin pregnancy, resulted in preterm labor. Maternal cardiovascular events occurred in 4 (heart failure and arrhythmias in 3 and arrhythmia in 1), and all were controllable with medications. Risk factors for the peripartum cardiac events were older age at ASO and delivery, and higher concentration of brain natriuretic peptide (BNP) at first trimester (p<0.05). In 7-60 month-follow-up after delivery, no case showed deterioration of functional class and systemic ventricular function. According to the literature review, women after ASO demonstrated a better prognosis than those after the atrial switch operation. CONCLUSIONS: The majority of women with d-TGA after ASO tolerated pregnancy and delivery well. The older age at ASO, an elderly pregnancy, and higher BNP levels at the first trimester were possibly risk factors of peripartum cardiovascular events among the group. The literature reviews and this study may indicate the advantage of systemic left ventricle compared with systemic right ventricle in long-term outcomes after delivery.
OBJECTIVE: Arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA) has gradually replaced the atrial switch operation and has become the standard operation. To date, the outcomes of pregnant women with d-TGA after this new operation have not been investigated. In this study, we investigated the impact of ASO on pregnant outcomes and mid-term prognosis in women with d-TGA and compared with the atrial switch operation through the literature review. METHODS AND RESULTS: There were 20 pregnancies in 10 women with d-TGA after ASO and 6 resulted in abortion. Among 14 successful pregnancies in 10 women, 11 pregnancies achieved the term delivery and 3 pregnancies, including 1 twin pregnancy, resulted in preterm labor. Maternal cardiovascular events occurred in 4 (heart failure and arrhythmias in 3 and arrhythmia in 1), and all were controllable with medications. Risk factors for the peripartum cardiac events were older age at ASO and delivery, and higher concentration of brain natriuretic peptide (BNP) at first trimester (p<0.05). In 7-60 month-follow-up after delivery, no case showed deterioration of functional class and systemic ventricular function. According to the literature review, women after ASO demonstrated a better prognosis than those after the atrial switch operation. CONCLUSIONS: The majority of women with d-TGA after ASO tolerated pregnancy and delivery well. The older age at ASO, an elderly pregnancy, and higher BNP levels at the first trimester were possibly risk factors of peripartum cardiovascular events among the group. The literature reviews and this study may indicate the advantage of systemic left ventricle compared with systemic right ventricle in long-term outcomes after delivery.
Authors: Kathryn J Lindley; C Noel Bairey Merz; Anita W Asgar; Natalie A Bello; Sonal Chandra; Melinda B Davis; Mardi Gomberg-Maitland; Martha Gulati; Lisa M Hollier; Eric V Krieger; Ki Park; Candice Silversides; Natasha K Wolfe; Carl J Pepine Journal: J Am Coll Cardiol Date: 2021-04-13 Impact factor: 24.094
Authors: Oktay Tutarel; Karishma P Ramlakhan; Lucia Baris; Maria T Subirana; Judith Bouchardy; Attila Nemes; Niels G Vejlstrup; Olga A Osipova; Mark R Johnson; Roger Hall; Jolien W Roos-Hesselink Journal: J Am Heart Assoc Date: 2020-12-22 Impact factor: 5.501