Author + information
- Received May 19, 2003
- Revision received October 24, 2003
- Accepted November 24, 2003
- Published online July 7, 2004.
- Gruschen R Veldtman, MBChB, MRCP*,
- Heidi M Connolly, MD, FACC*,* (, )
- Martha Grogan, MD, FACC*,
- Naser M Ammash, MD, FACC* and
- Carole A Warnes, MD, MRCP, FACC*
- ↵*Reprint requests and correspondence:
Dr. Heidi M. Connolly, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
Objectives We sought to determine pregnancy outcomes in patients with tetralogy of Fallot (TOF).
Background Pregnancy outcomes in patients with TOF are incompletely defined.
Methods Clinical, hemodynamic, and obstetric data were reviewed for women with TOF and prior pregnancy.
Results Of 72 respondents, 43 (mean age, 26 years) had 112 pregnancies (range, 1 to 5); 82 pregnancies were successful. Eight women had unrepaired TOF at the time of their 20 successful pregnancies. At first assessment (age ≥18 years), six patients had pulmonary hypertension, three had moderate or severe right ventricular (RV) systolic dysfunction, and 13 had severe RV dilation due to pulmonic regurgitation. Sixteen patients had 30 miscarriages (27%) and one term stillbirth. Mean overall birth weight was 3.2 kg (range, 2.1 to 4.2 kg). Unrepaired TOF (p = 0.05) and morphologic pulmonary artery abnormality (p = 0.03) were independently predictive of infant birth weight. Six patients had cardiovascular complications during pregnancy: supraventricular tachycardia in two, heart failure in two, pulmonary embolism in a patient with pulmonary hypertension, and progressive RV dilation in a patient with severe pulmonic regurgitation. Five infants (6%) had congenital anomalies.
Conclusions Patients with TOF have an increased risk of fetal loss, and their offspring are more likely to have congenital anomalies than offspring in the general population. Adverse maternal events, although rare, may be associated with left ventricular dysfunction, severe pulmonary hypertension, and severe pulmonic regurgitation with RV dysfunction.
- Received May 19, 2003.
- Revision received October 24, 2003.
- Accepted November 24, 2003.
- American College of Cardiology Foundation