Bartczak-Rutkowska Agnieszka, Tomkiewicz-Pająk Lidia, Kawka-Paciorkowska Katarzyna, Bajorek Natalia, Ciepłucha Aleksandra, Ropacka-Lesiak Mariola, Trojnarska Olga
1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland.
J Clin Med. 2023 Jan 18;12(3):783. doi: 10.3390/jcm12030783.
Women with single ventricle physiology after the Fontan procedure, despite numerous possible complications, can reach adulthood and give birth. Pregnancy poses a hemodynamic burden for distorted physiology of Fontan circulation, but according to the literature, it is usually well tolerated unless the patient is a "failing" Fontan. Our study aimed to assess maternal and fetal outcomes in patients after the Fontan procedure followed up in two tertiary Polish medical centers. We retrospectively evaluated all pregnancies in women after the Fontan procedure who were followed up between 1995-2022. During the study period, 15 women after the Fontan procedure had 26 pregnancies. Among 26 pregnancies, eleven ended with miscarriages, and 15 pregnancies resulted in 16 live births. Fetal complications were observed in 9 (56.3%) live births, with prematurity being the most common complication ( = 7, 43.8%). We recorded 3 (18.8%) neonatal deaths. Obstetrical complications were present in 6 (40%) out of 15 completed pregnancies-two (13.3%) cases of abruptio placentae, two (13.3%) pregnancies with premature rupture of membranes, and two (13.3%) patients with antepartum hemorrhage. There was neither maternal death nor heart failure decompensation during pregnancy. In two (13.3%) women, atrial arrhythmia developed. One (6.7%) patient in the second trimester developed ventricular arrhythmia. None of the patients suffered from systemic thromboembolism during pregnancy. Pregnancy in women after the Fontan procedure is well tolerated. However, it is burdened by a high risk of miscarriage and multiple obstetrical complications. These women require specialized care provided by both experienced cardiologists and obstetricians.
接受Fontan手术的单心室生理女性患者，尽管存在诸多可能的并发症，但仍可成年并生育。妊娠会给Fontan循环的扭曲生理带来血流动力学负担，但根据文献，除非患者处于Fontan循环“功能衰竭”状态，通常能较好耐受。我们的研究旨在评估在波兰两家三级医疗中心接受随访的Fontan手术后患者的母婴结局。我们回顾性评估了1995年至2022年期间接受随访的Fontan手术后女性的所有妊娠情况。在研究期间，15名接受Fontan手术的女性有26次妊娠。在26次妊娠中，11次以流产告终，15次妊娠产下16名活婴。9例（56.3%）活产出现胎儿并发症，早产是最常见的并发症（7例，43.8%）。我们记录到3例（18.8%）新生儿死亡。15例足月妊娠中有6例（40%）出现产科并发症——2例（13.3%）胎盘早剥、2例（13.3%）胎膜早破妊娠以及2例（13.3%）产前出血患者。孕期既无孕产妇死亡也无心力衰竭失代偿情况。2例（13.3%）女性出现房性心律失常。1例（6.7%）孕中期患者出现室性心律失常。所有患者孕期均未发生系统性血栓栓塞。Fontan手术后女性的妊娠耐受性良好。然而，其流产风险和多种产科并发症风险较高。这些女性需要经验丰富的心脏病专家和产科医生提供的专业护理。
