Successful pregnancy in a patient with a single ventricle

Complex congenital heart disease in a complicated and precious pregnancy

A single ventricle is a rare congenital heart disease that accounts for less than 1% of all congenital heart diseases. A woman was assessed in our obstetric clinic for the first time at the gestational age of 28 weeks and found to have placental bleeding. She also had complex congenital heart disease and atrial fibrillation requiring anticoagulation. Echocardiography revealed double-inlet single ventricle with right and left atrioventricular valves entering into this chamber and levo-transposition of the great arteries. After an extensive discussion with the patient regarding the risks and benefits of anticoagulation including risk of stroke, the agreed plan was to start her on intravenous heparin with close observation and to continue pregnancy for at least 32 weeks in order to reduce the postpartum risk for the fetus. The pregnancy progressed without any further complications and the patient had elective caesarean section at 33 weeks of gestation and delivered a healthy baby boy.

Successful pregnancy and delivery in a woman with a single ventricle and Eisenmenger syndrome

BACKGROUND

Patients with a single ventricle represent a rare abnormality found in 1% of patients with congenital heart disease, often discovered during childhood. Without pulmonary stenosis, the disease can progress to fixed pulmonary hypertension. Both pregnancy and delivery are risky events capable of increasing the right-to-left shunt. Pregnancy is contraindicated.

CASE

We report the case of a 27-year-old woman with a single ventricle without pulmonary protection and fixed pulmonary hypertension at 60 mmHg, discovered during a pregnancy. The delivery was obtained by cesarean section with epidural anesthesia and the patient was perioperatively treated with nitric oxide. Though contraindicated, pregnancy and delivery were successfully achieved in this patient.

COMMENT

Patients with single ventricle and Eisenmenger syndrome rarely reach adult life. Pregnancy with this condition is exceptional and fundamentally perturbs hemodynamic stability. In spite of the development of anesthesia and resuscitation and the description of some cases in literature, pregnancy with Eisenmenger syndrome is contraindicated.

Successful pregnancy in a patient with univentricular heart and pulmonary stenosis

Univentricular heart or single ventricle heart is a rare and complex congenital heart disease (CHD). We report the successful management of a parturient with a single ventricle, and pulmonary stenosis. The univentricular heart is discussed in detail and the maternal and fetal outcome in pregnant women with CHD is reviewed.

[General anaesthesia for Caesarean section in a patient with pulmonary atresia and an intact intraventricular septum]

We report the case of a 22-year-old primigravida patient presenting pulmonary atresia with intact ventricular septum, a rare congenital heart disease. Caesarean delivery was performed at 32 weeks of gestation because of moderate maternal function deterioration and foetal growth restriction. General anaesthesia was used because of the presence of lumbar Harrington rods. The administration of etomidate, celocurine and a continuous perfusion of remifentanil right from induction ensured haemodynamic stability and a rapid emergence and recovery.

[Single ventricle and obstetric anaesthesia: two cases report]

Single ventricle is a relatively rare abnormality found only in 0.5-1.5% of patients with congenital heart disease. Pregnancy results in an increased maternal morbidity and mortality in patients with right to left shunting, especially in cases associated with pulmonary hypertension and polycythemia and decreased arterial oxygen saturation. Most complications arise from decreases in systemic vascular resistance, causing an increase in right to left shunting and further hypoxemia and acidosis. For this reason, the major regional anaesthetic techniques are often avoided in these patients. The authors reported two successful management of regional anaesthesia for both caesarean and vaginal delivery.

Pregnancy and the univentricular heart: case report and literature review

The univentricular heart is a rare form of congenital cardiac disease. We report the successful management of a parturient with a single ventricle, transposition of the great arteries, pulmonary hypertension and thrombosis of the superior vena cava. The univentricular heart is discussed in detail and the outcome in other mothers with similar cardiac anomalies is reviewed.

Pregnancy and heart disease: a review

About one per cent of all pregnancies are affected by maternal heart disease, which may have significant influence on the maternal and foetal outcome. In this context rheumatic heart disease is declining and congenital heart disease is becoming the dominant category. Our experience of pregnancy in the new groups of patients created by paediatric heart surgery is scant and a continuous update is required.