Clarkson P M, Wilson N J, Neutze J M, North R A, Calder A L, Barratt-Boyes B G
Department of Cardiology, Green Lane Hospital, Auckland, New Zealand.
J Am Coll Cardiol. 1994 Jul;24(1):190-3. doi: 10.1016/0735-1097(94)90562-2.
This study examined the outcome of pregnancy in patients with transposition of the great arteries and an intact ventricular septum after a Mustard operation.
Before the introduction of surgical treatment, most children with transposition of the great arteries died in early infancy. A number of these patients have now reached their reproductive years. There is little information about the effect of pregnancy on cardiovascular status, particularly the ability of the right ventricle to adjust to the hemodynamic changes of pregnancy. The outcome for the offspring and their risk of congenital heart disease are also unknown.
Twenty-three female late survivors after the Mustard operation > 15 years of age were reviewed in relation to the occurrence of pregnancy and its outcome. Serial echocardiographic estimates of right ventricular volume during pregnancy were made in three local patients.
Nine women had 15 pregnancies. They were asymptomatic before pregnancy and remained free from cardiac symptoms during each pregnancy. Right ventricular volume in the three patients studied increased during pregnancy but returned to normal at 8 to 11 weeks postpartum. There were 12 live births, 2 spontaneous abortions and 1 intrauterine death. None of the liveborn infants had evidence of congenital heart disease.
In this small group of women with good quality late survival after a Mustard operation, pregnancy was well tolerated. We suspect that the incidence of congenital heart disease in infants of mothers with transposition of the great arteries will be at the lower end of the range for mothers with different types of congenital heart disease, but further data will be needed to confirm this.
本研究探讨了大动脉转位且室间隔完整的患者在Mustard手术后的妊娠结局。
在手术治疗方法出现之前，大多数大动脉转位的儿童在婴儿早期死亡。现在，其中一些患者已到生育年龄。关于妊娠对心血管状态的影响，尤其是右心室适应妊娠血流动力学变化的能力，几乎没有相关信息。后代的结局及其患先天性心脏病的风险也未知。
对23名年龄大于15岁、Mustard手术后的女性晚期存活者进行了妊娠发生情况及其结局的回顾性研究。对三名当地患者在孕期进行了系列超声心动图评估右心室容积。
9名女性共妊娠15次。她们妊娠前无症状，每次妊娠期间均无心脏症状。所研究的三名患者的右心室容积在孕期增加，但产后8至11周恢复正常。有12例活产、2例自然流产和1例宫内死亡。所有活产婴儿均无先天性心脏病的证据。
在这一小群Mustard手术后晚期存活质量良好的女性中，妊娠耐受性良好。我们怀疑大动脉转位母亲的婴儿患先天性心脏病的发生率将处于不同类型先天性心脏病母亲发生率范围的下限，但需要更多数据来证实这一点。
