Paediatric-onset coronary artery anomalies in pregnancy: a single-centre experience and systematic literature review

Michelle Keir, Catriona Bhagra, Debra Vatenmakher, Francisca Arancibia-Galilea, Katrijn Jansen, Norihisa Toh, Candice K. Silversides, Jack Colman, Samuel C. Siu, Mathew Sermer, Andrew M. Crean, Rachel M. Wald

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Individuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population. Methods: We performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death. Results: A total of 25 surveys were mailed, and 20 were returned (80% response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59% of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23%, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18%, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14%) and included heart failure (n=5, 5%), myocardial infarction (n=7, 7%), maternal death (n=2, 2%), cardiac arrest secondary to ventricular fibrillation (n=1, 1%), and stroke (n=1, 1%). The majority of maternal events (13/14, 93%) occurred in women with no previous diagnosis of coronary disease. Conclusions: Women with paediatric-onset coronary artery anomalies have a 14% risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalCardiology in the Young
DOIs
Publication statusAccepted/In press - Apr 17 2017

Fingerprint

Coronary Vessels
Pediatrics
Pregnancy
Heart Arrest
Stroke
Myocardial Infarction
Coronary Aneurysm
Maternal Death
Needs Assessment
Pregnancy Complications
Ventricular Fibrillation
Pulmonary Edema
Pregnancy Outcome
Multicenter Studies
Coronary Disease
Cardiac Arrhythmias
Heart Failure
Mothers
Prospective Studies
Population

Keywords

  • anomalous aortic origin of a coronary artery
  • anomalous left coronary artery from the pulmonary artery
  • Congenital coronary anomalies
  • Kawasaki disease
  • pregnancy outcomes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Paediatric-onset coronary artery anomalies in pregnancy : a single-centre experience and systematic literature review. / Keir, Michelle; Bhagra, Catriona; Vatenmakher, Debra; Arancibia-Galilea, Francisca; Jansen, Katrijn; Toh, Norihisa; Silversides, Candice K.; Colman, Jack; Siu, Samuel C.; Sermer, Mathew; Crean, Andrew M.; Wald, Rachel M.

In: Cardiology in the Young, 17.04.2017, p. 1-9.

Research output: Contribution to journalArticle

Keir, M, Bhagra, C, Vatenmakher, D, Arancibia-Galilea, F, Jansen, K, Toh, N, Silversides, CK, Colman, J, Siu, SC, Sermer, M, Crean, AM & Wald, RM 2017, 'Paediatric-onset coronary artery anomalies in pregnancy: a single-centre experience and systematic literature review', Cardiology in the Young, pp. 1-9. https://doi.org/10.1017/S1047951117000658
Keir, Michelle ; Bhagra, Catriona ; Vatenmakher, Debra ; Arancibia-Galilea, Francisca ; Jansen, Katrijn ; Toh, Norihisa ; Silversides, Candice K. ; Colman, Jack ; Siu, Samuel C. ; Sermer, Mathew ; Crean, Andrew M. ; Wald, Rachel M. / Paediatric-onset coronary artery anomalies in pregnancy : a single-centre experience and systematic literature review. In: Cardiology in the Young. 2017 ; pp. 1-9.
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abstract = "Objectives: Individuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population. Methods: We performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death. Results: A total of 25 surveys were mailed, and 20 were returned (80{\%} response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59{\%} of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23{\%}, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18{\%}, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14{\%}) and included heart failure (n=5, 5{\%}), myocardial infarction (n=7, 7{\%}), maternal death (n=2, 2{\%}), cardiac arrest secondary to ventricular fibrillation (n=1, 1{\%}), and stroke (n=1, 1{\%}). The majority of maternal events (13/14, 93{\%}) occurred in women with no previous diagnosis of coronary disease. Conclusions: Women with paediatric-onset coronary artery anomalies have a 14{\%} risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.",
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AU - Bhagra, Catriona

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AU - Arancibia-Galilea, Francisca

AU - Jansen, Katrijn

AU - Toh, Norihisa

AU - Silversides, Candice K.

AU - Colman, Jack

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N2 - Objectives: Individuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population. Methods: We performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death. Results: A total of 25 surveys were mailed, and 20 were returned (80% response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59% of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23%, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18%, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14%) and included heart failure (n=5, 5%), myocardial infarction (n=7, 7%), maternal death (n=2, 2%), cardiac arrest secondary to ventricular fibrillation (n=1, 1%), and stroke (n=1, 1%). The majority of maternal events (13/14, 93%) occurred in women with no previous diagnosis of coronary disease. Conclusions: Women with paediatric-onset coronary artery anomalies have a 14% risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.

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KW - Kawasaki disease

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