Canobbio M M, Mair D D, van der Velde M, Koos B J
University of California Los Angeles School of Nursing 90095-1702, USA.
J Am Coll Cardiol. 1996 Sep;28(3):763-7. doi: 10.1016/0735-1097(96)00234-3.
This study sought to determine risks and outcome of pregnancy and delivery after the modified Fontan operation.
Increasingly, female Fontan patients reaching child-bearing years are interested in having children. To date, the number of reported pregnancies is small, and pregnancy has therefore been discouraged.
One hundred ten of 126 female patients from the Fontan registries of the Mayo Clinic and University of California Los Angeles Medical Center responded to a mailed questionnaire. An additional six patients with a reported pregnancy from other centers were identified and reviewed to assess pregnancy outcomes.
Among the participating centers, a total of 33 pregnancies after Fontan operation for various types of univentricular heart disease were reported. There were 15 (45%) live births from 14 mothers, with 13 spontaneous abortions and 5 elective terminations. In the 14 women with live births, the median number of years between operation and pregnancy was 4 (range 2 to 14). Reported prepregnancy problems in these gravidas included atrial flutter in one patient and ventricular dysfunction, aortic regurgitation and atrioventricular valve regurgitation in another. One patient developed supraventricular tachycardia during pregnancy and had conversion to sinus rhythm. No maternal cardiac complications were reported during labor, delivery or the immediate puerperium. There were six female and nine male infants (mean gestational age 36.5 weeks; median weight 2,344 g). One infant had an atrial septal defect. At follow-up, mothers and infants were alive and well.
Pregnancy after the Fontan operation appears to have been well tolerated in 13 to 14 gravidas. There does appear to be an increased risk of miscarriage. The tendency to routinely discourage pregnancy may need to be reconsidered.
本研究旨在确定改良Fontan手术后妊娠及分娩的风险和结局。
越来越多达到生育年龄的Fontan手术女性患者对生育感兴趣。迄今为止，报道的妊娠病例数量较少，因此一直不鼓励妊娠。
梅奥诊所和加州大学洛杉矶分校医学中心Fontan登记处的126名女性患者中有110名回复了邮寄的问卷。另外确定并审查了来自其他中心的6例有妊娠报道的患者，以评估妊娠结局。
在参与研究的中心，共报道了33例因各种类型单心室心脏病接受Fontan手术后的妊娠。14名母亲中有15例（45%）活产，13例自然流产，5例选择性终止妊娠。在14例活产的女性中，手术至妊娠的中位年数为4年（范围2至14年）。这些孕妇孕前报道的问题包括1例患者发生心房扑动，另1例患者存在心室功能障碍、主动脉瓣反流和房室瓣反流。1例患者在孕期发生室上性心动过速，后转为窦性心律。分娩期间、分娩时或产后即刻均未报道有母亲心脏并发症。有6名女婴和9名男婴（平均孕周36.5周；中位体重2344g）。1例婴儿患有房间隔缺损。随访时，母亲和婴儿均存活且状况良好。
13至14例孕妇对Fontan手术后的妊娠耐受性似乎良好。流产风险确实似乎有所增加。可能需要重新考虑常规不鼓励妊娠的倾向。
