Pregnancy and hereditary heart disease. Type of surgery affects prognosis. 5
What can a woman with heart disease do to plan the pregnancy? What should she do during pregnancy to ensure the health of the mother and her future child? To start with, it’s very important to plan the pregnancy, and beforehand to have a clinic devoted to pre-pregnancy counseling by the cardiologist in charge and by an obstetrician who is familiar with heart defects. Things may be extremely different according to the type of heart disease. First of all, I must apologize. Dr. Marc Dommergues. I’m not a cardiologist, so I’m going to oversimplify heart-related matters. But we might consider a few examples. First, let’s discuss a pregnant woman who has been operated for an atrial septal defect [ASD]. It means there was a hole between her heart atria when she was born, and this hole was corrected by surgery. If we imagine a woman who had no complication of that surgery, who has normal heart ventricles, a normal heart rate, then the pregnancy is going to be very similar in her to pregnancy in anybody else. However, there might be some anxiety either from the patient or from doctors. This is something that must be taken into account. But this pregnant woman with the atrial septal defect has been cured by heart surgery. Suppose we consider another heart defect, which is the transposition of the great arteries. Transposition of the great arteries means that it is a pulmonary artery that rises from the left ventricle and the aorta that arises from the right ventricle. When you’re a baby, when you are just a newborn, this means you are going to be blue, hypoxic, because the blood is not going to move correctly between the heart and the lungs, and the heart and the rest of the body. You need to have emergency surgery. Once you have been operated on [for this heart problem], the impact on pregnancy will depend on the type of surgery you had. If you had one of the older types of surgery, which is called “atrial switch,” that means that your aorta is still going to come out of your right ventricle. But the surgeon has managed to switch the blood flow at the level of the atria. This means that the blood coming from the lung is going to go to the right ventricle. Dr. Marc Dommergues. Medical second opinion. And from the right ventricle, blood goes to the rest of the body. This means the body is going to get blood full of oxygen. Dr. Anton Titov, MD. So that’s all very nice! The only problem is that the right ventricle has to pump a huge load of blood under high pressure. The right ventricle is not made for that, and you may have a certain degree of heart failure. This will be very important to assess before pregnancy because things will be very different, if your right ventricle is still pumping the blood perfectly well, or if it’s a little bit tired. In the former case, it is likely that the pregnancy will be without any problem. In the latter case, it will be quite different. Dr. Anton Titov, MD. There will be a risk of heart failure during pregnancy. However, even with the first situation, it is not unusual that all doesn’t work as well by the end of the pregnancy when the right ventricle has a lot of loads to manage. You may also have heart failure following delivery. This means that a very close follow-up is going to be needed by the obstetrician but also by the cardiologist throughout pregnancy. They have to check for heart failure or abnormality of the rhythm of the heart. If, in contrast, the surgery was an arterial switch, then the surgeon succeeded in doing something that I always find extraordinary. Aorta was put back to the right place, and the pulmonary artery is back to the right ventricle. Then you have a virtually normal heart. Everybody is going to be worried because this is a rare condition. Dr. Marc Dommergues. Medical second opinion. And there’s going to be a very close obstetrical and cardiac monitoring, But by the end of the day usually, everything ends up normally.
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