Osmers R, Osmers M, Bartmus D, Ruschewski W, Kuhn W
Universitäts-Frauenklinik, Göttingen.
Z Geburtshilfe Neonatol. 1995 Sep-Oct;199(5):195-8.
Up to now pregnancy in patients with a previous Fontan operation for definitive palliation of a univentricular heart has been regarded as contraindicated. Two cases of a pregnancy after Fontan operation and univentricular heart were published in the literature. In a single case a successful delivery of the fetus could be achieved. The presented case is the third published pregnancy after Fontal operation and the second with a successful fetal outcome. The 30 years old patient was born with a univentricular heart of right ventricular type with tricuspid and pulmonary atresia and persisting arterial duct. After bilateral Blalock Taussig anastomoses (1966) and modified Waterston-Cooley-anastomosis (1974) a primary existing cyanosis could be improved. The cyanosis was completely abolished after definitive repair with the Fontan operation at the age of 17 (1980). The course of pregnancy and its surveillance is reported. In the 32nd week of gestation cesarean section had to be performed because of threatening cava compression. A healthy female fetus of 1275 g was delivered. The mother's postoperative recovery was uneventful. Meanwhile the neonate and the mother have been discharged and are in good clinical condition.
迄今为止，对于曾接受Fontan手术以最终姑息治疗单心室心脏的患者，怀孕一直被视为禁忌。文献中发表了两例Fontan手术后单心室心脏患者怀孕的病例。其中仅有一例成功分娩出胎儿。本文所呈现的病例是Fontan手术后第三例发表的怀孕病例，也是第二例胎儿结局成功的病例。该30岁患者出生时为右心室型单心室心脏，伴有三尖瓣和肺动脉闭锁以及动脉导管未闭。在进行双侧Blalock Taussig吻合术（1966年）和改良的Waterston-Cooley吻合术（1974年）后，原有的青紫症状有所改善。17岁（1980年）时接受Fontan手术进行确定性修复后，青紫症状完全消除。本文报告了该患者的妊娠过程及其监测情况。妊娠32周时，由于存在腔静脉受压风险，不得不进行剖宫产。分娩出一名体重1275克的健康女婴。母亲术后恢复顺利。与此同时，新生儿和母亲均已出院，临床状况良好。
