An Analysis Of Cases With Repaired Tetralogy Of Fallot During The Second And Third Trimester

?Objective? To evaluate the clinical characteristic and pregnancy outcome in women with repaired Tetralogy of Fallot during the middle and late trimester.?Research object and methods? 1. Research object: The study was a retrospective analysis of maternal and perinatal outcome in women with repaired Tetralogy of Fallot(the observation group) in Beijing Anzhen Hospital, Capital Medical University during January 2007 to May 2015. Meanwhile, 80 pregnant women without heart disease who was randomly chosen have been the control group, and been compared to the observation group. 2. Stratification in observation group: 1) according to age of cardiac surgery, patients in the observation group are grouped into age>12-year-old group and age ? 12-year-old group, then we have analyzed cardiac function and pregnancy outcome indicators between them; 2) according to residual shunt, patients in the observation group would be divided into people with residual shunt and people without residual shunt, then we have analyzed cardiac function and pregnancy outcome indicators between them; 3) according to tricuspid regurgitation, patients in the observation group would be divided into people without tricuspid regurgitation, people with mild-to-moderate tricuspid regurgitation and people with severe tricuspid regurgitation, then we have analyzed cardiac function and pregnancy outcome indicators between them; 4) according to pulmonary regurgitation, patients in the observation group would be divided into people without pulmonary regurgitation and people with pulmonary regurgitation, then we have analyzed cardiac function and pregnancy outcome indicators between them. 3. Standard of diagnosis: standard of diagnosis about repaired Tetralogy of Fallot refer to signs, symptoms, medical history, history of heart surgery, echocardiography and electrocardiogram. Cardiovascular complications refer to echocardiography. Arrhythmia need drug to treat, cardiac function deterioration, heart failure and infective endocarditis have been as a cardiovascular event. Cardiac function refer to the New York Heart Association(NYHA) cardiac functional grading. Obstetrical complications were diagnosed by obstetrician. 4. Observation indexes: 1)cardiovascular complication indexes: cardiac function, residual shunt, tricuspid regurgitation, cardiovascular event, pulmonary regurgitation, pulmonary hypertension. Pregnancy outcome indexes: gestational age, term delivery, delivery mode, preterm delivery,premature infant, birth weight, low birth weight infant, neonatal asphyxia. The criterion for the comparison between the observation group and control group: age, gestational age, delivery mode, preterm delivery, premature infant, birth weight, low birth weight infant. The criterion for the comparison in observation group: cardiac function, term delivery, preterm delivery, premature infant, birth weight, low birth weight infant.?Result? 1.General data of the observation group: among 38 cases in the surgical group, 32 patients got favorable outcome, 2 cases with severe preeclampsia, 3 cases with more serious cardiac function, 1 case with infectious endocarditis and heart failure. 32 cases in 38cases(84.2%) have got term delivery, 6 cases with preterm delivery(gestational age of one case is less than 28weeks). 2.Compared to the control group, the observation group was younger, gestational weeks of them were longer, birth weight of their babies were more heavier and cesarean section rate, incidence of premature birth, premature birth rate, low birth weight were higher[(27±5)years vs(30±4)years,(37.3±2.6)weeks vs(39.1±1.2)weeks, 3 075(2 753,3 413)g vs 3 350(3 150,3 590)g, 86.8%(33/38) vs 52.5%(42/80), 10.5%(4/38) vs 1.3%(1/80), 11.1%(4/38) vs 1.3%(1/80), 11.1%(4/38) vs 0.0%(0/80), P<0.05]. 3.Stratification in the observation group:(1) the New York Heart Association(NYHA) cardiac functional grading, rate of term delivery, rate of low birth weight infant in patients who underwent cardiac surgery before 12-year-old were better [heart function ?~? class 30%(3/10) vs 0.0%( 0/28), 92.9%( 26/28) vs 60%( 6/10), 3145(2788,3518)g vs 2905(2453,3083)g,P<0.05];(2) the New York Heart Association(NYHA) cardiac functional grading and birth weight(BW)in patients with residual shunt were more bad than those without residual shunt[heart function ?~? class 60.0%(3/5) vs 0.0%(0/33), 2 650(1 590,2 848)g vs 3 135(2 873,3 518)g, P<0.05];(3) the NYHA cardiac functional grading, rate of term delivery and BW in patients with severe tricuspid regurgitation were more bad than ones without tricuspid regurgitation or with mild-to-moderate tricuspid regurgitation [heart function ?~? class 50.0%(2/4) vs 0.0%(0/3), 3.2%(1/31); 25.0(1/4) vs 100.0%(3/3), 90.3(28/31);(1270,2385,2 640)g vs(2 650,3 000,3300)g, 3 135(2 878,3 545)g; P<0.05];(4)there are no notable difference between patients with pulmonary regurgitation and ones without pulmonary regurgitation in NYHA cardiac functional grading, term delivery, preterm delivery, premature infant, birth weight and low birth weight infant.?Conclusion? Women with corrected Tetralogy of Fallot can adapt to hemodynamic change during the second and third trimester with improved maternal and perinatal outcome and not as health as the control group. For women with corrected Tetralogy of Fallot, age of cardiac surgery, residual shunt, severe tricuspid regurgitation are probably important factors to effect pregnancy outcome. Under joint supervision of an obstetrician, a cardiologist and a congenital cardiac surgeon, age of cardiac surgery, residual shunt, severe tricuspid regurgitation would be considered.