OUTCOME OF PREGNANCY AFTER THE MUSTARD OPERATION FOR TRANSPOSITION OFTHE GREAT-ARTERIES WITH INTACT VENTRICULAR SEPTUM

Objectives. This study examined the outcome of pregnancy in patients w ith transposition of the great arteries and an intact ventricular sept um after a Mustard operation. Background. Before the introduction of s urgical treatment, most children with transposition of the great arter ies died in early infancy. A number of these patients have now reached their reproductive years. There is little information about the effec t of pregnancy on cardiovascular status, particularly the ability of t he right ventricle to adjust to the hemodynamic changes of pregnancy. The outcome for the offspring and their risk of congenital heart disea se are also unknown. Methods. Twenty-three female late survivors after the Mustard operation >15 years of age were reviewed in relation to t he occurrence of pregnancy and its outcome. Serial echocardiographic e stimates of right ventricular volume during pregnancy were made in thr ee local patients. Results. Nine women had 15 pregnancies. They were a symptomatic before pregnancy and remained free from cardiac symptoms d uring each pregnancy, Right ventricular volume in the three patients s tudied increased during pregnancy but returned to normal at 8 to 11 we eks postpartum. There were 12 live births, 2 spontaneous abortions and 1 intrauterine death. None of the liveborn infants had evidence of co ngenital heart disease. Conclusions. In this small group of women with good quality late survival after a Mustard operation, pregnancy was w ell tolerated. We suspect that the incidence of congenital heart disea se in infants of mothers with transposition of the great arteries will be at the lower end of the range for mothers with different types of congenital heart disease, but further data will be needed to confirm t his.