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Non-cardiac complications during pregnancy in women with isolated congenital pulmonary valvar stenosis
  1. W Drenthen1,
  2. P G Pieper1,
  3. J W Roos-Hesselink2,
  4. A C M Schmidt1,
  5. B J M Mulder3,
  6. A P J van Dijk4,
  7. H W Vliegen5,
  8. K M Sollie6,
  9. A A Voors1,
  10. T Ebels7,
  11. D J van Veldhuisen1,
  12. on behalf of the ZAHARA investigators
  1. 1Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
  4. 4Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
  5. 5Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  6. 6Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
  7. 7Department of Thoracic Surgery, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to:
    W Drenthen
    Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands;w.drenthen{at}


Background: Information on the outcome of pregnancy in patients with pulmonary valvar stenosis is scarce, mostly limited to cardiac complications observed during pregnancy.

Objectives: To investigate the magnitude and determinants of non-cardiac and fetal risks during pregnancy of women with isolated pulmonary valvar stenosis.

Methods: Using the nationwide registry (CONgenital CORvitia), 106 women with (un-)corrected pulmonary valvar stenosis receiving care in six tertiary medical centres in The Netherlands were included. A total of 51 women had 108 pregnancies, including 21 (19%) miscarriages and 6 elective abortions.

Results: In the 81 completed (>20 weeks of gestation) pregnancies, we observed a high number of hypertension-related disorders (n = 12, 15%, including pre-eclampsia (n = 4) and eclampsia (n = 2)), premature deliveries (n = 14, 17%, including one twin) and thromboembolic events (n = 3, 3.7%). Furthermore, recurrence of congenital heart defects in the offspring was detected in three children (3.7%, pulmonary valvar stenosis (n = 2) and complete transposition of the great arteries in combination with anencephaly). In addition to the intrauterine fetal demise of the transposition child, three other children died shortly after birth owing to immaturity, hydrocephalus combined with prematurity and meningitis (overall offspring mortality, 4.8%).

Conclusion: In this largest report on pregnancy in women with (un-) corrected isolated pulmonary valvar stenosis, an excessive number of (serious) non-cardiac complications and mortality were observed in the offspring.

  • CHD, congenital heart disease
  • PIH, pregnancy-induced hypertension

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  • Published Online First 3 July 2006

  • Funding: This study is supported by a Netherlands Heart Foundation Grant 2002 B125 to PGP and the Interuniversity Cardiology Institute, the Netherlands (ICIN). DJvanV is an established investigator of the Netherlands Heart Foundation (grant D97.017).

  • Competing interests: None.

  • Ethical approval: The institutional review board or ethics committee at each participating centre (UMCG Groningen, AMC/UVA Amsterdam, EMC Rotterdam, LUMC Leiden, UMC St Radboud Nijmegen, UMCU Utrecht) approved the protocol before patient inclusion.