H. Reinecke et al., PREGNANCY IN PATIENTS AFTER MUSTARD PROCE DURE FOR TRANSPOSITION OF THE GREAT-ARTERIES - A CASE-REPORT AND REVIEW OF THE LITERATURE, Zeitschrift fur Kardiologie, 86(11), 1997, pp. 945-956
Background: In patients after atrial switch operation (Mustard or Senn
ing procedure) for transposition of the great arteries (TGA), the anat
omic right (anterior) ventricle works as the systemic ventricle. Altho
ugh this is associated with an increased rate of congestive heart fail
ure, the prognosis for long-term survival is good. Therefore a large p
roportion of these patients has reached their reproductive years and c
onsult cardiologists and obstetricians because they plan a pregnancy o
r are already pregnant. Because of the substantial hemodynamic changes
and the increase in cardiac output during pregnancy, potential risk f
actors and complications have to be considered. Patients: Initiated by
the presentation of a pregnant patient with TGA after surgery in our
hospital, we analyzed the information referenced in MEDLINE. Including
our patient, there were reports on 27 patients after the Mustard proc
edure with a total of 39 pregnancies. Fetal outcome: Three abortions o
ccurred during the first trimenon, another one was electively induced
because of maternal cardiac deterioration. One late abortion occurred
in the 23rd week of pregnancy. 35 babies (one twinpair) were born heal
thy without cardiovascular anomalies. Maternal outcome: No maternal de
aths occurred. Eight women developed clinical signs of systemic (= rig
ht) heart failure including all three patients with former complex TGA
. Four of these patients recovered after delivery, four showed persist
ent reduction of physical abilities or signs of heart failure. Further
complications were supraventricular tachycardias (five patients) and
a high incidence of hypertension and pre-eclampsia (22 % of patients).
Conclusion: Overall, the outcome for mothers after Mustard procedure
for TGA and their children is good, but there is need for intensive an
d specialized follow-up.