Medical advances have increased survival of patients with congenital heart disease. However, cardiac disease in pregnancy carries significant maternal and fetal risks, posing enormous challenges to obstetricians. Cyanotic congenital heart disease is associated with maternal complications such as arrhythmias, thromboembolic events and death. Fetal complications include small for gestational age, miscarriage and prematurity. Cyanotic congenital heart disease patients who continue their pregnancies require holistic multidisciplinary team care with early and coordinated planning for delivery. Management of such patients include early counseling regarding pregnancy-associated risks, close monitoring of their cardiac function and regular scanning for fetal assessment. Choice of anesthesia for these patients requires meticulous planning to achieve a favorable balance between systemic and pulmonary vascular resistance, ensuring minimal change in right-to-left shunting. We report a case of a successfully managed pregnancy in a patient with complex congenital heart disease and a single ventricle of left ventricle morphology.
European Society of Gynecology, Association for European Paediatric Cardiology, German Society for Gender Medicine, Authors/Task Force Members, Regitz-Zagrosek V, Blomstrom Lundqvist C, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 3147–3197.
2.
PerloffJKHistorical perspective. In: PerloffJKChildJS (eds). Congenital heart disease in adults, Philadelphia: WB Saunders, 1998, pp. 3–8.
3.
ChamaidiAGatzoulisMA. Heart disease and pregnancy. Hellenic J Cardiol2006; 47: 275–291.
4.
DhanardhonoTThiaE. Incidence and outcome of prenatally diagnosed, chromosomally normal congenital heart defects in Singapore. Singapore Med J2012; 53: 643–647.
5.
KinareSGSivaramanADeshpandeJ. Single ventricle (morphologic study of 21 cases). Indian Heart J1989; 41: 301–306.
6.
TheodoridisTDAnagnostouEZepiridisL. Successful pregnancy and caesarean section delivery in a patient with single ventricle and transposition of the great arteries. J Obstet Gynaecol2005; 25: 69–70.
7.
AmithaVKSahajaSKMallikarjunG. Pregnancy outcome in a rare case of complex cyanotic congenital heart disease. Int J Reprod Contracept Obstet Gynecol2015; 4: 250–251.
8.
NiloferARZakiSA. Successful pregnancy in a patient with univentricular heart and pulmonary stenosis. Heart Views2012; 13: 71–73.
9.
WendlingAL. Seller A and Peterson E. Case report of a parturient with cyanotic congenital heart disease palliated with a Glenn Procedure. J Clin Anesth2012; 24: 586–589.
10.
RahimtoolaSHOngleyPASwanHJ. The haemodynamits of the common ventricle. Circulation1966; 34: 14–14.
11.
SteinbergEHDantzkerDR. Single ventricle with severe pulmonary hypertension: natural survival into the third decade of life. Am Heart J1993; 125: 1451–1453.
12.
OptowskyASiddiqiOD’ZouzaB. Maternal cardiovascular events during childbirth among women with congenital heart disease. Heart2011; 98: 145–151.
13.
SiuJM. Colman Cardiovascular problems and pregnancy: an approach to management. Cleve Clin J Med2004; 71: 977–985.
14.
AbbasAELesterSJConnollyH. Pregnancy and the cardiovascular system. Int J Cardiol2005; 98: 179–189.
15.
Cunningham FG, Leveno KJ, Bloom SL, et al. Williams obstetrics. In: Cunningham FG (ed) Cardiovascular disease. 23rd ed. USA: McGraw-Hill Companies, 2010, pp. 958–982.
16.
PresbiteroPSomervilleJStoneS. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation1994; 89: 2673–2676.
17.
WhittemoreRHobbinsJEngleM. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol1982; 50: 6–6.
18.
GelsonECurryRGatzoulisMA. Effect of maternal heart disease on fetal growth. Obstet Gynecol2011; 118(2 Pt 1): 364–364.
19.
Regitz-ZagrosekVLundqvistCBBorghiC. Task Force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology: expert consensus document on management of cardiovascular diseases during pregnancy. Eur Heart J2003; 24: 761–781.
20.
WarnesCWilliamsRBashoreT. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). J Am Coll Cardiol2008; 52: e142–e263.
21.
RychikJAyresNCuneoB. American Society of echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr2004; 17: 803–810.
22.
DrenthenWBoersmaEBalciA. ZAHARA Investigators. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J2010; 31: 2124–2132.
23.
CosteloeK. The EPICure Study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics2000; 106: 659–671.
24.
TamannaMEnidMHJonathanM. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ2012; 345: e7961–e7961.
25.
JohnsonSHennessyESmithR. Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study. Arch Dis Child Fetal Neonatal Ed2009; 94: F283–F289.
26.
PrydePGMittendorfR. Contemporary usage of obstetric magnesium sulfate: indication, contraindication, and relevance of dose. Obstet Gynecol2009; 114: 669–669.
27.
BoyleRK. Anaesthesia in parturient with heart disease, a five-year review in an Australian tertiary hospital. Int J Obstet Anesth2003; 12: 173–177.
28.
BucklandRPickettJA. Pregnancy and the univentricular heart: case report and literature review. Int J Obstet Anesth2000; 9: 55–63.
29.
NishimuraRAOttoCMBonowRO. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol2014; 63: e57–e185.
30.
AvilaWSGrinbergMSnitcowskyR. Maternal and fetal outcome in pregnant women with Eisenmenger’s syndrome. Eur Heart J1995; 16: 460–464.
31.
JonesAMHowittG. Eisenmenger’s syndrome in pregnancy. BMJ1965; 1: 1627–1631.
32.
KoosBJ. Clinical management of pregnant women with congenital heart disease. In: Pitkin RM (moderator) Pregnancy and congenital heart disease. Ann Intern Med1990; 112: 445–454.
