PREGNANCY AFTER THE FONTAN PROCEDURE FOR TRICUSPID-ATRESIA - A CASE-REPORT

BACKGROUND: Pregnancy is contraindicated in uncorrected tricuspid atre sia. Even following palliative surgery with the Fontan procedure, only four pregnancies have been reported. CASE: A 32-year-old female prese nted at 8 weeks' gestation in her first pregnancy with a history of th e Fontan procedure performed seven years earlier for cardiac decompens ation despite two previous palliative procedures for tricuspid atresia . She remained class I with no deterioration and required no medicatio n throughout the pregnancy. Amniocentesis for positive maternal alpha- fetoprotein screening was normal. The pregnancy was complicated by ant epartum hemorrhage at 29 weeks and premature rupture of membranes at 3 3 weeks, resulting in preterm labor and delivery of a 2.5-kg infant fi ve days later. Apart from postpartum hemorrhage, the puerperium was un eventful, and the patient was well 20 weeks after delivery. CONCLUSION : Five similar pregnancies, including this one, have been reported. Al though all were successful, three infants were preterm and two growth retarded. This observation suggests that for these patients, pregnancy must be monitored closely even though the mothers may be hemodynamica lly stable.