Cardiac magnetic resonance imaging characteristics and pregnancy outcomes in women with Mustard palliation for complete transposition of the great arteries

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• 作者：Laura Jimenez Juan^a ; ¹ ; Anne Marie Valente^b ; ¹ ; Candice K. Silversides^c ; ^d ; ¹ ; Tal Geva^b ; ¹ ; Jack M. Colman^c ; ^d ; ¹ ; S. Lucy Roche^c ; ¹ ; Samuel C. Siu^c ; ^d ; ^e ; ¹ ; Rachel M. Wald^c ; ^d ; ^f ; ¹ ; ^{Rachel.wald@uhn.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ACHD ; Adult congenital heart disease ; BP ; Blood pressure ; CMR ; Cardiovascular magnetic resonance imaging ; EF ; Ejection fraction ; NYHA ; New York Heart Association ; RVEDV ; Right ventricular end diastolic volume ; RVEF ; Right ventricular ejection fraction ; RV ; Right ventricle ; SSFP ; Steady state free precession ; TGA ; Transposition of the great arteries ; TR ; Tricuspid valve regurgitation
• 刊名：IJC Heart & Vasculature
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：10
• 期：Complete
• 页码：54-59
• 全文大小：312 K

文摘

Women with transposition of the great arteries (TGA) following atrial redirection surgery are at risk of pregnancy-associated arrhythmia and heart failure. The cardiovascular magnetic resonance imaging (CMR) characteristics of these women and the relationship of CMR findings to pregnancy outcomes have not been described.

Methods

We included 17 women with atrial redirection surgery and CMR within 2 years of delivery.

Results

All women were asymptomatic at baseline (New York Heart Association Class 1). CMR studies were completed pre-pregnancy in 3, antepartum/peripartum in 2, and postpartum in 12 women. Three women (3/17, 18%) experienced major cardiovascular events related to pregnancy: cardiac arrest (n = 1) and symptomatic atrial arrhythmia (n = 2). Median gestational age at delivery was 38 weeks (24–39 weeks) and birth weight was 2770 g (2195–3720 g). Complications were seen in 3 offspring (3/17, 18%): death (n = 1) and prematurity (n = 2). CMR characteristics included median right ventricular end diastolic volume 119 mL/m² (range 85–214 mL/m²) and median right ventricular ejection fraction (RVEF) 37% (range 30–51%). All women with cardiovascular complications had an RVEF < 35% (range 32–34%). The association between RVEF < 35% and cardiovascular complications trended towards statistical significance (p = 0.05). No statistically significant differences in CMR measurements were found between those with and without neonatal complications.

Conclusions

While the majority of women in this cohort had successful outcomes following pregnancy, important cardiovascular complications were seen in a significant minority, all of whom had an RVEF < 35%. The preliminary findings of our study provide impetus for a larger prospective study to evaluate the prognostic role of CMR in pregnant women with atrial redirection surgery.