Carta Acesso aberto Revisado por pares

How Pregnancy Impacts Adult Cyanotic Congenital Heart Disease

2017; Lippincott Williams & Wilkins; Volume: 135; Issue: 24 Linguagem: Inglês

10.1161/circulationaha.116.027152

ISSN

1524-4539

Autores

Magalie Ladouceur, Louise Benoit, Adeline Basquin, Jelena Radojevic, Quentin Hauet, Sébastien Hascoët, Pamela Moceri, Laurianne Le Gloan, Pascal Amédro, Hugues Lucron, Adelaide Richard, Marielle Gouton, J. Nizard,

Tópico(s)

Coronary Artery Anomalies

Resumo

HomeCirculationVol. 135, No. 24How Pregnancy Impacts Adult Cyanotic Congenital Heart Disease Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBHow Pregnancy Impacts Adult Cyanotic Congenital Heart DiseaseA Multicenter Observational Study Magalie Ladouceur, MD, PhD, Louise Benoit, Adeline Basquin, MD, Jelena Radojevic, MD, Quentin Hauet, MD, Sébastien Hascoet, MD, Pamela Moceri, MD, PhD, Laurianne Le Gloan, MD, Pascal Amedro, MD, PhD, Hugues Lucron, MD, Adelaide Richard, MD, Marielle Gouton, MD and Jacky Nizard, MD, PhD Magalie LadouceurMagalie Ladouceur From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Louise BenoitLouise Benoit From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Adeline BasquinAdeline Basquin From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Jelena RadojevicJelena Radojevic From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Quentin HauetQuentin Hauet From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Sébastien HascoetSébastien Hascoet From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Pamela MoceriPamela Moceri From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Laurianne Le GloanLaurianne Le Gloan From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Pascal AmedroPascal Amedro From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Hugues LucronHugues Lucron From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Adelaide RichardAdelaide Richard From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). , Marielle GoutonMarielle Gouton From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). and Jacky NizardJacky Nizard From Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France (M.L., S.H.); Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris Centre de Recherche Cardiovasculaire, INSERM U970, France (M.L.); Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (L.B., J.N.); Centre de Compétence des Malformations Cardiaques Congénitales Complexes, M3C, Service de Cardiologie, CHU de Rennes, France (A.B.); Cardiologie Congénitale, Strasbourg, France (J.R.); Pediatric and Congenital Cardiology Department, University Hospital, CHU d'Angers, France (Q.H.); Department of Congenital Heart Diseases, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Sud, Université Paris Sud, Université Paris-Saclay, Plessis-Robinson, France (S.H.); Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, France (P.M.); Adult Congenital Heart Disease, Institut du thorax, CHU de Nantes, France (L.L.); Pediatric and Congenital Cardiology Department, M3C Regional Reference Center, University Hospital, Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, France (P.A.); Pediatric and Congenital Cardiology Department, M3C Regional Antilles-Guyane Tertiary Care Center, University Hospital of Martinique, FWI, Fort de France (H.L.); Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France (A.R.); Cardiology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France (M.G.); and Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150 (J.N.). Originally published13 Jun 2017https://doi.org/10.1161/CIRCULATIONAHA.116.027152Circulation. 2017;135:2444–2447Survival into adulthood of patients with unrepaired cyanotic congenital heart defects (CHDs) is possible when cyanotic CHDs are deemed unsuitable for radical surgical repair but are compatible with survival. These situations include, for example, complex pulmonary atresia with aortopulmonary collaterals and single-ventricle hearts (with and without earlier palliation). This is also the case when patients with cyanotic CHDs reach adulthood without serious symptoms requiring surgery, such as those with mild tetralogy of Fallot, Ebstein's anomaly, and some cases of corrected transposition of the great arteries with pulmonary stenosis and ventricular septal defect. Many women with these heart conditions wish to become pregnant, which creates a situation of high maternal and fetal risks of complications.1 Management of these patients before, during, and after pregnancy has improved, with an earlier recognition of the underlying disease, improved understanding of cardiopulmonary physiopathology, better prenatal and peri-partum obstetric/anesthetic management, and the introduction of a multidisciplinary approach.2We retrospectively reviewed the charts of all pregnant women with cyanotic CHDs (n=51) who were followed in 11 adult CHD referral centers from the M3C French network (Center de référence des Malformations Cardiaques Congénitales Complexes) between 1997 and 2015. We included patients with central cyanosis on effort or at rest, with appropriate cardiac anatomy underpinning this condition. We excluded for this study patients with pulmonary arterial hypertension, which concerned patients with either Eisenmenger syndrome (n=17) or segmental pulmonary hypertension confirmed invasively (group 5 according to the latest classification of pulmonary hypertension,3 n=3). The ethical review board of each institution approved the study, and all patients provided written informed consent. The study population was divided into 4 groups according to the cyanosis mechanism as previously described by Presbitero et al (Table).1 We collected data on the demographic, clinical, and biological characteristics. Cardiac complications (arrhythmia, heart failure requiring treatment, systemic thromboembolic complication, worsening of hypoxemia [decrease in saturation at rest >5% compared with basal saturation, leading to a hospitalization], and infective endocarditis) were documented. A mixed logistic regression, with number of pregnancies nested within each individual, was used to determine risk factors for maternal cardiovascular complications.Table 1. Baseline Maternal Characteristics and Maternal OutcomesGroup 1 (n=7): ventricular R-L shunt and systemic LVGroup 2 (n=18): univentricular heartGroup 3 (n=4): ventricular R-L shunt and systemic RVGroup 4 (n=2): atrial R-L shuntGlobal (n=31)Principal cardiac lesions and baseline maternal characteristics Principal cardiac lesions4 tetralogy of Fallot; 3 pulmonary atresia+VSD+MAPCA18 congenital heart diseases with single-ventricle physiology3 L-TGA+VSD+PS or pulmonary atresia; 1 D-TGA+VSD2 Ebstein's anomaly+ASD Cardiac surgeries1 BT; 2 RV-PA stenotic conduit4TCPC; 2 Blalock-Taussig; 1 pulmonary banding; 2 Glenn; 1 SV-PA stenotic conduit1 Mustard; 1 LV- PA stenotic conduit; 1 repair*016 (52%) History of cardiovascular event†24118 (26%) Systemic ventricular function Normal7172228 (90%) Moderately impaired0110 Severely impaired0010 Maternal treatment None671216 (52%) Diuretics01001 (3%) Antiarrhythmics05207 (23%) Receiving anticoagulants or antiplatelet drugs1 ASA8 ASA and 1 VKA1 ASA011 (35%) Risk scores,2 mean [max to min] CARPREG11.25 [1 to 3]1.2 [1 to 3]11.11 [1 to 3] ZAHARA2.29 [1 to 3.25]2.70 [1 to 4.75]2.88 [1 to 4.75]1.36 [1 to 1.75]2.3 [1 to 4.75] Age, y28±8.026±5.527±11.422.827±6 Pregestational body mass index, kg/m225.8±8.422.6±5.419.5±0.819.022.4±4.5 NYHA I/II/III/IV1/6/0/04/13/1/01/2/1/00/2/0/06/22/3/0 Oxygen saturation at rest, %88±788±491±192 and 9589±2 Hemoglobin, g/dL16.1±1.115.7±2.614.6±1.314.9 and 15.014.9±1.8Maternal outcomes of completed pregnancies, n/n' completed pregnancies, % Maternal cardiac complications4/13 (31%)7/25 (28%)2/8 (25%)0/213/48 (27%) Heart failure1210 Arrhythmia1100 Deep hypoxemia‡2310 Infective endocarditis0100 Anticoagulation therapy Prophylactic191011 (23%) Curative01102 (4%) Antiplatelet drugs13105 (10%) No anticoagulation or antiplatelet drug11125230 (63%) Cardiac treatment Diuretics0300 Antiarrhythmics1210Maternal characteristics at last follow-up Cardiovascular event†352111/31 (35%) Systemic ventricular systolic function Normal5162225/31 (81%) Moderately impaired2200 Severely impaired0020 NYHA I/II/III/IV0/4/3/04/11/3/01/1/2/00/2/0/05/18/8/0 Oxygen saturation, %88±690±292±193 and 9589±5ASA indicates acetylsalicylic acid; ASD, atrial septal defect; BT, Blalock-Taussig anastomosis; CARPREG, Cardiac Disease in Pregnancy; LV-PA, left ventricle-pulmonary artery; MAPCA, major aortopulmonary collateral artery; NYHA, New York Heart Association; PB, pulmonary banding; PS, pulmonary stenosis; R-L, right to left; RV, right ventricle; RV-PA, right ventricle-pulmonary artery; SV-PA, single ventricle-pulmonary artery; TCPC, total cavopulmonary connection; TGA, transposition of the great arteries; VKA, vitamin K antagonist; VSD, ventricular septal defect; and ZAHARA, Zwangerschap bij Aangeboren Hartafwijkingen. No significant difference was observed among the 4 groups. n indicates the number of completed pregnancies.*Repair consisted of closure of VSD and a conduit placement between the left ventricle and the main pulmonary artery.†Cardiovascular events included heart failure, arrhythmia, thromboembolism, and infective endocarditis.‡Deep hypoxemia was defined by a decrease in saturation at rest >5% compared with basal saturation or leading to a hospitalization.Our population consisted of 71 pregnancies in 31 patients (Table). Fifteen patients (48%) had undergone previous palliative shunts and remained cyanotic. Systemic ventricle function was normal in all but 2 patients with moderately to severely impaired systolic function before pregnancy. No patient died during pregnancy or the postpartum period. Cardiovascular complications occurred in 13 completed pregnancies (27%, 95% confidence interval, 14–46) in 10 patients (32%, 95% confidence interval, 17–51). Three patients developed heart failure and 2 experienced de novo supraventricular tachycardia. The more common complication was worsening of hypoxemia (n=7), requiring hospitalization in 3 cases. No maternal baseline characteristics, listed in Table, were statistically predictive of cardiovascular complications. Anticoagulation treatment was given in 13 pregnancies and antiplatelet agents in 5. No thromboembolic complication was recorded during pregnancy or the postpartum period. Streptococcus milleri infective endocarditis occurred in the postpartum period in 1 patient who did not receive peripartum antibiotic prophylaxis. At last follow-up (median 3.8 years, 95% confidence interval, 0.9–14.8), no patients died, but 4 (13%) developed chronic heart failure, with deterioration in New York Heart Assocation functional class from II to III, associated with a decrease in systolic ventricular function on echocardiography, from normal before pregnancy to moderately impaired at last follow-up in 3 patients and from moderately impaired to severely impaired in 1. Furthermore, New York Heart Assocation functional class was impaired in 3 other patients without documented systolic ventricle dysfunction and without significant decrease in oxygen saturation. Moreover, atrial arrhythmia occurred in 8 patients, ventricular tachycardia in 1, and stroke in 5. Among the 10 patients who experienced cardiovascular complications during pregnancy, 3 had subsequent heart failure or arrhythmia.These findings, with no maternal death, indicate that patients with cyanotic CHDs can carry a pregnancy and deliver with lower maternal risks than previously described.1 This difference may be explained by recent improvement of the high-risk pregnancies prenatal and peripartum management with a multidisciplinary approach2 and impact of preconception counseling. With only a quarter of our population receiving anticoagulation or antiplatelet therapy, it is difficult to associate this treatment with the absence of thromboembolic complications. Prophylactic anticoagulation may be more relevant during the postpartum period because postpartum maternal thromboembolic risk is increased at least 3-fold compared with the risk during pregnancy.4Long-term outcome in this cohort is characterized by 13% risk of late chronic heart failure. Systemic ventricle function was semiquantitatively assessed with echocardiography. This method is limited in complex CHDs, and heart failure diagnosis could be underestimated. Larger prospective studies on pregnancy-related complications of patients with cyanotic CHDs are needed to develop more rigorous conclusions and elucidate the impact of pregnancy on this unique patient population with cyanotic CHDs.Magalie Ladouceur, MD, PhDLouise BenoitAdeline Basquin, MDJelena Radojevic, MDQuentin Hauet, MDSébastien Hascoet, MDPamela Moceri, MD, PhDLaurianne Le Gloan, MDPascal Amedro, MD, PhDHugues Lucron, MDAdelaide Richard, MDMarielle Gouton, MDJacky Nizard, MD, PhDAcknowledgmentsThe authors thank Lucile Offredo from Inserm U970, Paris Cardiovascular Research Center, for her help in statistical analysis.DisclosuresNone.FootnotesCirculation is available at http://circ.ahajournals.org.Correspondence to: Magalie Ladouceur, MD, PhD, Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. E-mail [email protected]References1. 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June 13, 2017Vol 135, Issue 24 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.116.027152PMID: 28606952 Originally publishedJune 13, 2017 Keywordsheart failurepregnancyhypoxiacongenital heart diseasePDF download Advertisement SubjectsCongenital Heart DiseaseHeart FailurePregnancy

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