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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 291-295    DOI: 10.31083/j.ceog.2020.02.5235
Original Research Previous articles | Next articles
Pregnancy outcomes in women with congenitally corrected transposition of the great arteries
D. Yang1, H. F. Zhang1, Q. Liu1, Y. N. Li1, J. Zhang1, *(), T. Zheng2
1Department of Obstertrics and Gynecology, Medical Center of Severe Cardiovascular of Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
2Department of Cardiac Surgery, Medical Center of Severe Cardiovascular of Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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Abstract  

The aim of this study was to define the pregnancy outcomes in women with congenitally corrected transposition of the great arteries (cc-TGA). The medical databases at Anzhen Hospital between January 2011 and March 2018 were retrospectively reviewed. Data of 12 pregnant women with cc-TGA were collected. One patient was lost at 35 weeks of gestation. There were 8 (72.7%) term births and 3 (27.3%) premature births. Of the 11 deliveries, 2 (18.2%) were vaginal and 9 (81.8%) were cesarean. The baseline New York Heart Association (NYHA) functional class was I - II in 11 patients, II - III in 7 patients, and III - IV in 5 patients in the third trimester (P = 0.037). In the third trimester, 6 (50%) patients became symptomatic and experienced heart function deterioration compared with asymptomatic patients (6 vs. 0, P = 0.002). In the third trimester, tricuspid regurgitation (TR) was identified in 11 patients: 2 with mild TR, 4 with moderate TR, and 5 with severe TR. Five symptomatic patients developed severe TR, in which the rate of TR was significantly higher than that of asymptomatic patients (5 vs. 0, P = 0.015). No difference was found in NYHA class between the third trimester and 1 week after delivery (P > 0.05). One patient died of ventricular fibrillation at 3 months postpartum. Successful pregnancy can be achieved by most women with cc-TGA. The deterioration of right ventricular function is common among pregnant women with cc-TGA, and severe TR is a high risk factor resulting in deterioration of the right ventricular function.

Key words:  pregnancy      congenitally corrected transposition of the great artery      systemic right ventricle     
Published:  15 April 2020     
*Corresponding Author(s):  J. Zhang     E-mail:  zhangjundoc@126.com

Cite this article: 

D. Yang, H. F. Zhang, Q. Liu, Y. N. Li, J. Zhang, T. Zheng. Pregnancy outcomes in women with congenitally corrected transposition of the great arteries. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 291-295.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.02.5235     OR     https://ceog.imrpress.com/EN/Y2020/V47/I2/291

Table 1  — Baseline characteristics in women with cc-TGA
Patient Number Age Parity Type of TGA Other cardiac defect and arrhythmia NYHA class before pregnancy
1 27 0 IDD Dexiocardia, pulmonary atresia, VSD, ASD II
truncus arteriosus communis, CRBBB
2 24 1 SLL VSA, ASD II
3 21 0 SLL VSA, ASD I
4 30 0 SLL APB I
5 34 1 SLL APB I
6 23 0 SLL VSD, PS I
7 30 1 SLL Ebstein’s Anomaly, II-AVB I
8 27 0 SLL - I
9 30 1 SLL - I
10 29 0 SLL Dexiocardia I
11 24 0 SLL - II
12 26 0 SLL Bicuspid aortic valve associated with mild aor- I
tic valve stenosis
Table 2  — Clinical data during pregnancy
Patient number Symptom Occurrence time Cardiac complication Bnp (pg/ml) SpO2 (%) Obstetrical complication
1 Yes 31 PAH - 84 -
2 No - 38 98.8 -
3 No - - 95.8 -
4 Yes 36 Sinus tachycardia 87 98.9 -
5 Yes 28 HF 2760 99.6 Sever PE
6 Yes 36 Sinus tachycardia 123 98 -
7 No - 55 97.3 -
8 No - - - 98.3 GDM
9 No - - 84 98.9
10 No - - 168 96.1
11 Yes 25 62 98.3
12 Yes 33 Sinus tachycardia 96 97.7
Table 3  — Heart function class and Echocardiographic parameters in 3rd trimester and 1 week after delivery
Patient
Number
NYHA class
3rd trimester 1 week after delivery
EF of SRV (%)
3rd trimester 1 week after delivery
Degree of TR
3rd trimester 1 week after delivery
1 55 52 Moderate Mild
2 53 50 Moderate Moderate
3 60 50 Moderate Moderate
4 60 60 Severe Mild
5 53 46 Severe Moderate
6 40 - Severe Severe
7 50 55 Moderate Mild
8 60 60 Mild Mild
9 - - Mild Mild
10 56 55 None None
11 - 45 - Severe -
12 55 59 Severe Severe
Table 4  — Mode of delivery, use of anaesthesia, and fetal outcome
Patient Number Gestational age at birth Mode of delivery Anaesthesia Birthweight (g) Apgar score
1 31+3 CS Epidural 1520 2010/10/10
2 37 CS Epidural 3030 2010/10/10
3 39 CS Spinal 3660 2010/10/10
4 38 CS Epidural 3930 2010/10/10
5 30+6 CS Epidural 980 2007/8/9
6 38 CS Epidural 3530 2010/10/10
7 38+ CS Epidural 3630 2010/10/10
8 40 VD - 3700 2010/10/10
9 39 VD - 3350 2010/10/10
10 38+ CS Spinal 2930 2010/10/10
11 Loss of follow-up -
12 34+ CS Epidural 2850 2010/10/10
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