PREGNANCY IN PATIENTS AFTER MUSTARD PROCE DURE FOR TRANSPOSITION OF THE GREAT-ARTERIES - A CASE-REPORT AND REVIEW OF THE LITERATURE

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.