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Pregnancy Safe After Transposition of the Great Arteries Surgery

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NEW YORK (Reuters Health) – Women who have had the arterial switch operation to correct transposition of the great arteries tolerate pregnancy well with few complications, according to registry data.

“This is very important information because we can now counsel these patients and inform them that the risks of pregnancy are low,” Dr. Jolien W. Roos-Hesselink, director of the adult congenital heart disease program, Erasmus University Medical Center, Rotterdam, the Netherlands, told Reuters Health by email.

During the past 30 years, the arterial switch procedure has replaced the atrial switch procedure to correct transposition of the great arteries. “This technique seems to have better outcomes, but information on pregnancy in these women was scarce,” Dr. Roos-Hesselink explained.

In a report in the Journal of the American Heart Association, the researchers describe pregnancy outcomes in 41 women (mean age, 26.7 years) who had the arterial switch procedure for transposition of the great arteries. They were part of a worldwide prospective registry of pregnancy and cardiac disease (ROPAC) run by the European Society of Cardiology.

Most of the women had normal left (95.7%) and right (78.3%) ventricular systolic function before becoming pregnant, and in the women with serial echocardiographic data, there was no deterioration in left or right ventricular function during pregnancy.

None of the women died during pregnancy or up to six months after delivery and only two women (4.9%) suffered major adverse cardiovascular events.

One woman experienced heart failure. She had a history of a Blalock-Taussig shunt before the arterial switch procedure and had experienced heart failure symptoms before pregnancy.

One woman developed ventricular tachycardia during the second and third trimesters, which was effectively treated with metoprolol.

The median gestational age at delivery was 39 weeks and mean birth weight was 2962 grams.

There were seven (17.1%) preterm births at a median gestational age of 35 weeks and six (14.6%) low birth weight babies. Only one women suffered fetal loss (2.4%).

“During counseling, most women should be reassured that the risk of pregnancy is low,” the authors conclude in their paper.

“Many cardiologists are reluctant to give green light for pregnancy in these cardiac patients but our study proves that pregnancy is relatively safe. In my opinion, it is also very important to let women lead a normal life including pregnancy and starting a family,” Dr. Roos-Hesselink told Reuters Health.

SOURCE: https://bit.ly/3hBRyVe Journal of the American Heart Association, online December 22, 2020.

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