Most women tolerate pregnancy well after they undergo surgical repair of a congenital heart defect, although they face higher-than-normal rates of complications due to high blood pressure and miscarriage. The birth defect, called aortic coarctation, is diagnosed when the aorta, the major artery of the heart, is abnormally narrow, usually just past the point where the aorta meets the subclavian artery. Concerns have been raised about the safety of pregnancy in women who have undergone aortic coarctation repair, given sporadic reports of aortic rupture during pregnancy Researchers from the Academic Medical Center in Amsterdam identified 100 women who underwent repair of aortic coarctation. Among the 54 women with a history of pregnancy, there were 126 pregnancies, including 98 successful pregnancies, 22 miscarriages and 6 abortions. Pregnancy success rate was 78 percent including abortions, and 82 percent if abortions were excluded. Two infants died soon after birth, while four of the 98 children born had a congenital heart defect. Twenty-six pregnancies, or 22 percent, were complicated by high blood pressure disorders. However, no serious cardiovascular complications occurred. The 18-percent rate of miscarriage seen in the study was similar to that found in other studies for congenital heart disease in general. Eighty-seven percent of pregnancies in the current study were delivered vaginally, 6 percent were cesarean sections, while 3 were emergency caesarean sections. Based on the above findings, the researchers recommend cardiovascular assessment and genetic counseling for women who are contemplating pregnancy after repair of aortic coarctation, while women with high blood pressure or other cardiac conditions before pregnancy should be followed carefully for complications. The study demonstrates that excellent maternal and infant outcome of pregnancy can be obtained in women after repair of aortic coarctation using a conservative approach.
European Heart Journal,
November 2005