Features of the pregnancy and childbirth in patients with functional single ventricle after Fontan operation

Authors: Astafyeva T.A., Kovalev D.V., Astrakhantseva T.O., Podzolkov V.P.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/ 1997-3187-2023-17-1-65-76

For citation: Astafyeva T.A., Kovalev D.V., Astrakhantseva T.O., Podzolkov V.P. Features of the pregnancy and childbirth in patients with functional single ventricle after Fontan operation. Creative Cardiology. 2023; 17 (1): 65–76 (in Russ.). DOI: 10.24022/1997-3187-2023-17-1-65-76

Received / Accepted:  25.08.2022 / 29.03.2023

Keywords: partial or complete bypass of the right heart functionally single ventricle of heart pregnancy after Fontan procedure

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Abstract

Fontan procedure increases the life duration in patients with single ventricle circulation. The number of women who have reached child bearing age after Fontan procedure is steadily increasing. Specialists face the problem of possibility and safety of this group of patients to get pregnant and give birth to a child. The presented review highlights issues related to pregnancy and childbirth in women who previously underwent partial or complete bypass of the right heart.This problem has a critical scientific and practical value, but remains one of the most poorly studied and discussed in the medical society, since the pregnancy in this category of patients is associated with high-risk, both for mother and fetus. There is still no common approach to its management.

References

  1. Wu W., He J., Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990–2017. Medicine. 2020; 99: e20593.
  2. Рудаева Е.В., Мозес В.Г., Кашталап В.В., Захаров И.С., Елгина С.И., Рудаева Е.Г. Врожденные пороки сердца и беременность. Фундаментальная и клиническая медицина. 2019; 4 (3): 102–12. DOI: 10.23946/2500-0764-2019-4-3-102-112
  3. Becker S., Al Halees Z. First-cousin matings and congenital heart disease in Saudi Arabia. Community Genet. 1999; 2 (2–3): 69–73. DOI: 10.1159/000016189 4. Øyen N., Boyd H.A., Carstensen L., Søndergaard L., Wohlfahrt J., Melbye M. Risk of congenital heart defects in offspring of affected mothers and fathers. Circ. Genom. Precis. Med. 2022; 15 (4): e003533. DOI: 10.1161/CIRCGEN.121.003533
  4. Baumgartner H., De Backer J., Babu-Narayan S.V., Budts W., Chessa М., Diller G.-P. et al. ESC Scientific Document Group, 2020 ESC Guidelines for the management of adult congenital heart disease: The Task Force for the management of adult congenital heart disease of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Adult Congenital Heart Disease (ISACHD). Eur. Heart J. 2021; 42 (6): 563–645. DOI: 10.1093/eurheartj/ehaa554
  5. 2018 AHA/ACC Guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2019; 139 (14): e698–800. DOI: 10.1161/CIR.0000000000000603
  6. Gupta T., Thompson J., Lindley K.J. Management of the Fontan patient during pregnancy. Curr. Opin. Cardiol. 2023; 38 (3): 241–9. DOI: 10.1097/HCO.0000000000001046
  7. Baldini L., Librandi K., D'Eusebio Ch., Lezo A. Nutritional management of patients with fontan circulation: a potential for improved outcomes from birth to adulthood. 2022; 14 (19): 4055. DOI: 10.3390/nu14194055
  8. Corno A.F., Findley T.O., Salazar J.D. Narrative review of single ventricle: where are we after 40 years? Transl. Pediatr. 2023; 12 (2): 221–44. DOI: 10.21037/tp-22-573
  9. Morita A., Kido S., Hachisuga M., Nagata H., Hidaka N., Kato K. Twin pregnancy complicated by total placenta previa in a Fontan-palliated patient: a case report. Case Rep. Womens Health. 2018; 20: e00085. DOI: 10.1016/j.crwh.2018.e00085
  10. Nitsche J.F., Phillips S.D., Rose C.H., Brost B.C., Watson W.J. Pregnancy and delivery in patients with fontan circulation: a case report and review of obstetric management. Obstet. Gynecol. Surv. 2009; 64 (9): 607–14. DOI: 10.1097/OGX. 0b013e3181b279d6
  11. Сauldwell M., Von Klemperer K., Uebing A., Swan L., Steer Ph.J., Babu-Narayan S.V. et al. А cohort study of women with a Fontan circulation undergoing preconception counselling. Heart. 2016; 102 (7): 534–40. DOI: 10.1136/heartjnl2015-308788
  12. Pundi K.N., Pundi K., Johnson J.N., Dearani J.A., Bonnichsen C.R., Phillips S.D. et al. Contraception practicesand pregnancy outcome in patients after Fontan operation. Congenit. Heart Dis. 2016; 11 (1): 63–70. DOI: 10.1111/chd.12291
  13. Mehta N., Mitta S. Fontan circulation and implications for future reproduction. Obst. Med. 2017; 10 (3): 104–6. DOI: 10.1177/1753495X16676727
  14. Cauldwell M., Steer Ph.J., Bonner S., Asghar O., Swan L., Hodson K. et al. Retrospective UK multicentre study of the pregnancy outcomes of women with a Fontan repair. Heart. 2018; 104 (5): 401–6. DOI: 10.1136/heartjnl-2017-311763
  15. Bonner S.J., Asghar O., Roberts A., Vause S., Clarke B., Keavney B. Cardiovascular, obstetric and neonatal outcomes in women with previous Fontan repair. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017; 219: 53–6. DOI: 10.1016/j.ejogrb.2017.10.013
  16. Gouton M., Nizard J., Patel M., Sassolas F., Jimenez M., Radojevic J. et al. Maternal and fetal outcomes of pregnancy with Fontan circulation: a multicentric observational study. Int. J. Cardiol. 2015; 187: 84–9. DOI: 10.1016/j.ijcard.2015.03.344
  17. Podzolkov V.P., Minaev A.V., Yurlov I.A., Kovalev D.V., Medvedeva O.I. Case of a healthy child birth in the family of both parents undergone Fontan procedure. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2019; 20 (11–12): 1090–4 (in Russ.). DOI: 10.24022/1810-0694-2019-20-11-12-1090-1094
  18. Liu J.Y., Tan W.K., Tan E.L., Tan J.L., Tan L.K. A case of successfully managedpregnancy in a patient with complex cyanotic congenital heart disease. Obstet. Med. 2017; 10 (2): 88–92. DOI: 10.1177/1753495X16678487
  19. Mohamed M., Mohsin Sh., Atiyah M., Al Zahrani A., Alnajashi K. A rare case of successive preg nancies in a woman with complex cyanotic congenital heart disease after Glenn palliation. World J. Cardiovasc. Dis. 2017; 7: 423–8. DOI: 10.4236/wjcd.2017.712040
  20. Scott N.S. Management of cardiovascular disease during pregnancy. US Cardiol. Rev. 2018; 12 (2): 119–23. DOI: 10.15420/usc.2018.8.1
  21. An Hagen I.M., Roos-Hesselink J.W. Pregnancy in congenital heart disease: risk prediction and counselling. Heart. 2020; 106 (23): 1853–61. DOI: 10.1136/heartjnl-2019-314702
  22. Arif S., Chaudhary A., Clift P.F., Morris R.K., Selman T.J., Bowater S.E. et al. Pregnancy outcomes in patients with a Fontan circulation and proposal for a risk-scoring system: single centre experience. 2017; 1: 10. DOI: 10.1186/s40949-017-0012-8
  23. Driscoll D.J., Offord K.P., Feldt R.H., Schaff H.V., Puga F.J., Danielson G.K. Five- to fifteen-year follow-up after Fontan operation. Circulation. 1992; 85: 469–96. DOI: 10.1161/01.cir.85.2.469
  24. Collins R.T. 2nd., Chang D., Sandlin A., Goudie A., Robbins J.M. National in-hospital outcomes of pregnancy in women with single ventricle congenital heart disease. Am. J. Cardiol. 2017; 119 (7): 1106–10. DOI: 10.1016/j.amjcard.2016.12.015
  25. Afshar Y., Tan W., Jones W.M., Canobbio M., Lin J., Reardon L. et al. Maternal Fontan procedure is a predictor of a small-for-gestational-age neonate: a 10-year retrospective study. Am. J. Obstet. Gynecol. MFM. 2019; 1 (3): 100036. DOI: 10.1016/j.ajogmf.2019.100036
  26. Bartczak-Rutkowska A., Tomkiewicz-Pajak L., Kawka-Paciorkowska K., Bajorek N., Ciepłucha A., Ropacka-Lesiak M., Trojnarska O. Pregnancy outcomes in women after the Fontan procedure. J. Clin. Med. 2023; 12 (3): 783. DOI: 10.3390/jcm12030783
  27. Nair A., Radhakrishnan S., Iyer K.S. Twin pregnancy in a Fontan-palliated patient. Cardiol. Young. 2016; 26: 1221–4. DOI: 10.1017/S1047951116000561
  28. Inoue S., Masuyama H., Akagi T., Hiramatsu Y. Pregnancy and delivery in patients with Fontan circulation: a report of two cases. Obstet. Gynaecol. Res. 2013; 39 (1): 378–82. DOI: 10.1111/j.1447-0756.2012.01910.x
  29. Ropero A.G., Baskar Sh., Roos Hesselink J.W., Girnius A., Zentner D., Swan L. et al. Pregnancy in women with a fontan circulation. A systematic review of the literature. Circ. Cardiovasc. Qual. Outcomes. 2018; 11: e004575. DOI: 10.1161/CIRCOUTCOMES.117.004575
  30. Makatsariya A.D., Chevenak F.A., Bitsadze V.O. High risk pregnancy. Moscow; 2015 (in Russ.).
  31. Karsenty C., Zhao A., Marijon E., Ladouceur M. Risk of thromboembolic complications in adult congenital heart disease: a literature review. Arch. Cardiovasc. Dis. 2018; 111 (10): 613–20. DOI: 10.1016/j.acvd.2018.04.003
  32. Girnius A., Zentner D., Valente A.M., Pieper P.G., Economy K.E., Ladouceur M. et al. Bleeding and thrombotic risk in pregnant women with Fontan physiology. Heart. 2021; 107 (17): 1390–7. DOI: 10.1136/heartjnl-2020-317397
  33. Barbour L.A. Current concepts of anticoagulant therapy in pregnancy. Obstet. Gynecol. Clin. North. Am. 1997; 24: 499–521. DOI: 10.1016/s0889-8545(05)70319-3
  34. Wichert-Schmitt B., D'Souza R., Silversides C.K. Reproductive issues in patients with the Fontan operation. Can. J. Cardiol. 2022; 38 (7): 921–9. DOI: 10.1016/j.cjca.2022.04.020

About Authors

  • Tatyana A. Astafyeva, Cardiologist; ORCID
  • Dmitriy V. Kovalev, Dr. Med. Sci., Leading Researcher; ORCID
  • Tatyana O. Astrakhantseva, Dr. Med. Sci., Chief Researcher; ORCID
  • Vladimir P. Podzolkov, Dr. Med. Sci., Professor, Academician of RAS, Head of Department; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery