Pregnancy and delivery in patients with Fontan circulation: A report of two cases

Seiji Inoue, Hisashi Masuyama, Teiji Akagi, Yuji Hiramatsu

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Fontan operation is performed to provide palliation for patients with many forms of highly complex congenital heart disease that cannot support a biventricular circulation. Increasing numbers of women who have undergone these connections in childhood are now reaching their childbearing years, and some are becoming pregnant. The low flow and fixed cardiac output of a Fontan circulation poses a number of problems during pregnancy. Here, we report two cases of pregnancy and delivery with Fontan circulation. Case 1, who underwent Fontan procedure for congenital pulmonary atresia with intact vertical septum at age 7, delivered a male infant weighing 1073 g by cesarean section at 28 6/7 weeks due to massive genital bleeding. Case 2 underwent Fontan procedure for double inlet left ventricle and delivered by vacuum extraction a male infant weighing 2142 g, while monitoring central venous pressure at 37 5/7 weeks. The former had ascites and dose of diuretic had to be added at early pregnancy, and the latter had no adverse cardiac and obstetric events. These cases suggest that patients after adequate Fontan palliation could complete pregnancy without long-term cardiac sequelae, but might be complicated with cardiac or obstetrical events. Intensive care should be required with specialists, including a neonatologist, anesthesiologist and cardiologist. We have added a literature review of pregnancy with Fontan circulation, referring to previous reports.

Original languageEnglish
Pages (from-to)378-382
Number of pages5
JournalJournal of Obstetrics and Gynaecology Research
Volume39
Issue number1
DOIs
Publication statusPublished - Jan 2013

Fingerprint

Fontan Procedure
Pregnancy
Pulmonary Atresia
Central Venous Pressure
Critical Care
Vacuum
Diuretics
Ascites
Cesarean Section
Cardiac Output
Obstetrics
Heart Ventricles
Heart Diseases
Hemorrhage

Keywords

  • B-type natriuretic peptide
  • Congenital heart disease
  • Fontan circulation
  • Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Pregnancy and delivery in patients with Fontan circulation : A report of two cases. / Inoue, Seiji; Masuyama, Hisashi; Akagi, Teiji; Hiramatsu, Yuji.

In: Journal of Obstetrics and Gynaecology Research, Vol. 39, No. 1, 01.2013, p. 378-382.

Research output: Contribution to journalArticle

@article{a67b441f13154bc1b9ebaf0a65624d43,
title = "Pregnancy and delivery in patients with Fontan circulation: A report of two cases",
abstract = "Fontan operation is performed to provide palliation for patients with many forms of highly complex congenital heart disease that cannot support a biventricular circulation. Increasing numbers of women who have undergone these connections in childhood are now reaching their childbearing years, and some are becoming pregnant. The low flow and fixed cardiac output of a Fontan circulation poses a number of problems during pregnancy. Here, we report two cases of pregnancy and delivery with Fontan circulation. Case 1, who underwent Fontan procedure for congenital pulmonary atresia with intact vertical septum at age 7, delivered a male infant weighing 1073 g by cesarean section at 28 6/7 weeks due to massive genital bleeding. Case 2 underwent Fontan procedure for double inlet left ventricle and delivered by vacuum extraction a male infant weighing 2142 g, while monitoring central venous pressure at 37 5/7 weeks. The former had ascites and dose of diuretic had to be added at early pregnancy, and the latter had no adverse cardiac and obstetric events. These cases suggest that patients after adequate Fontan palliation could complete pregnancy without long-term cardiac sequelae, but might be complicated with cardiac or obstetrical events. Intensive care should be required with specialists, including a neonatologist, anesthesiologist and cardiologist. We have added a literature review of pregnancy with Fontan circulation, referring to previous reports.",
keywords = "B-type natriuretic peptide, Congenital heart disease, Fontan circulation, Pregnancy",
author = "Seiji Inoue and Hisashi Masuyama and Teiji Akagi and Yuji Hiramatsu",
year = "2013",
month = "1",
doi = "10.1111/j.1447-0756.2012.01910.x",
language = "English",
volume = "39",
pages = "378--382",
journal = "Journal of Obstetrics and Gynaecology Research",
issn = "1341-8076",
publisher = "Blackwell Publishing Asia",
number = "1",

}

TY - JOUR

T1 - Pregnancy and delivery in patients with Fontan circulation

T2 - A report of two cases

AU - Inoue, Seiji

AU - Masuyama, Hisashi

AU - Akagi, Teiji

AU - Hiramatsu, Yuji

PY - 2013/1

Y1 - 2013/1

N2 - Fontan operation is performed to provide palliation for patients with many forms of highly complex congenital heart disease that cannot support a biventricular circulation. Increasing numbers of women who have undergone these connections in childhood are now reaching their childbearing years, and some are becoming pregnant. The low flow and fixed cardiac output of a Fontan circulation poses a number of problems during pregnancy. Here, we report two cases of pregnancy and delivery with Fontan circulation. Case 1, who underwent Fontan procedure for congenital pulmonary atresia with intact vertical septum at age 7, delivered a male infant weighing 1073 g by cesarean section at 28 6/7 weeks due to massive genital bleeding. Case 2 underwent Fontan procedure for double inlet left ventricle and delivered by vacuum extraction a male infant weighing 2142 g, while monitoring central venous pressure at 37 5/7 weeks. The former had ascites and dose of diuretic had to be added at early pregnancy, and the latter had no adverse cardiac and obstetric events. These cases suggest that patients after adequate Fontan palliation could complete pregnancy without long-term cardiac sequelae, but might be complicated with cardiac or obstetrical events. Intensive care should be required with specialists, including a neonatologist, anesthesiologist and cardiologist. We have added a literature review of pregnancy with Fontan circulation, referring to previous reports.

AB - Fontan operation is performed to provide palliation for patients with many forms of highly complex congenital heart disease that cannot support a biventricular circulation. Increasing numbers of women who have undergone these connections in childhood are now reaching their childbearing years, and some are becoming pregnant. The low flow and fixed cardiac output of a Fontan circulation poses a number of problems during pregnancy. Here, we report two cases of pregnancy and delivery with Fontan circulation. Case 1, who underwent Fontan procedure for congenital pulmonary atresia with intact vertical septum at age 7, delivered a male infant weighing 1073 g by cesarean section at 28 6/7 weeks due to massive genital bleeding. Case 2 underwent Fontan procedure for double inlet left ventricle and delivered by vacuum extraction a male infant weighing 2142 g, while monitoring central venous pressure at 37 5/7 weeks. The former had ascites and dose of diuretic had to be added at early pregnancy, and the latter had no adverse cardiac and obstetric events. These cases suggest that patients after adequate Fontan palliation could complete pregnancy without long-term cardiac sequelae, but might be complicated with cardiac or obstetrical events. Intensive care should be required with specialists, including a neonatologist, anesthesiologist and cardiologist. We have added a literature review of pregnancy with Fontan circulation, referring to previous reports.

KW - B-type natriuretic peptide

KW - Congenital heart disease

KW - Fontan circulation

KW - Pregnancy

UR - http://www.scopus.com/inward/record.url?scp=84875742205&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875742205&partnerID=8YFLogxK

U2 - 10.1111/j.1447-0756.2012.01910.x

DO - 10.1111/j.1447-0756.2012.01910.x

M3 - Article

C2 - 22672849

AN - SCOPUS:84875742205

VL - 39

SP - 378

EP - 382

JO - Journal of Obstetrics and Gynaecology Research

JF - Journal of Obstetrics and Gynaecology Research

SN - 1341-8076

IS - 1

ER -