Congenital Heart Disease
Outcome of pregnancy following intervention for coarctation of the aorta

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Abstract

There are limited data regarding the outcome of pregnancy in women after intervention for coarctation of the aorta (CoA). The Texas Children’s Hospital Cardiac Database was used to identify female patients with CoA born before 1980 who had undergone balloon angioplasty or surgery. Patients with Turner’s syndrome and cyanotic congenital heart disease were excluded. A chart review and telephone interview were performed. Data collected included age at intervention, type of intervention, the need for reintervention, functional status, number of pregnancies, and pregnancy outcomes. Seventy-four patients met our criteria and we were able to contact 52. Eighteen patients (39%) were pregnant a total of 36 times. There were 3 spontaneous and 4 elective abortions. Preeclampsia complicated 4 pregnancies in 3 women (17% of primigravidas). One patient had systemic hypertension. Eleven infants were delivered by Cesarean section. There were 29 births, with an average weight of 3.0 kg. There were 5 preterm births, 4 to a teenage mother. Only 1 child (3%) had a congenital heart defect. Thus, in women with an arm-to-leg blood pressure gradient of <20 mm Hg after CoA repair, pregnancy is successful. The occurrence of congenital heart disease in the offspring was 3%. Preeclampsia was similar to that in the general population.

Section snippets

Methods

A search of the Texas Children’s Hospital Cardiology Database was performed to identify all female patients born before 1980, who had undergone a balloon angioplasty or surgical repair for CoA. Patients with Turner’s syndrome or cyanotic congenital heart disease were excluded. A medical record review and telephone interview were then performed for all patients able to be contacted. The following data were abstracted from the patients medical record: age at intervention for CoA, preintervention

Results

Seventy-four patients met inclusion criteria for the study, of which 52 were able to be contacted for follow-up. The mean age of the patients at the time of study was 25 years (range 17 to 42). One patient has fetal alcohol syndrome and another has mild mental retardation with congenital deafness. Associated cardiac lesions (Table I) were present in 34 of 52 patients (65.4%). The mean arm-to-leg blood pressure gradient before surgical repair or balloon angioplasty for CoA was 55 mm Hg.

Discussion

In patients with unrepaired native CoA, Abbott4 reported a 69% mortality by 40 years of age. Surgical repair of the aorta has been performed since 19445, 6 and balloon angioplasty of CoA has been performed since first described by Singer et al7 in 1982. Balloon angioplasty of recoarctation has been shown to be effective in relieving residual obstruction.8 Surgical repair and balloon angioplasty of aortic coarctation provide marked improvement or resolution of the hemodynamic obstruction, thus

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