Management of Fontan circulation in pregnancy: a multidisciplinary approach to care.

Autor: Wolfe NK; Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO. Electronic address: kassimna@wustl.edu., Sabol BA; Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO., Kelly JC; Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO., Dombrowski M; Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO; Critical Care Division, Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO., Benhardt AC; Critical Care Division, Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO., Fleckenstein J; Department of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, MO., Stout MJ; Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO., Lindley KJ; Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
Jazyk: angličtina
Zdroj: American journal of obstetrics & gynecology MFM [Am J Obstet Gynecol MFM] 2021 Jan; Vol. 3 (1), pp. 100257. Date of Electronic Publication: 2020 Oct 17.
DOI: 10.1016/j.ajogmf.2020.100257
Abstrakt: The Fontan operation was first performed in 1968 and is a palliative procedure for children born with single ventricle forms of congenital heart disease. Today, 70,000 patients worldwide have Fontan circulation today, half of them women, and with an expected 30-year survival of >80%, this population is expected to double in the next 20 years. The Fontan operation surgically redirects systemic venous blood return directly to the pulmonary circulation, bypassing the single ventricle. This abnormal anatomy results in significant challenges for the cardiovascular system and is marked by a sustained, abnormally elevated systemic venous pressure combined with decreased cardiac output. As more women with Fontan circulation reach childbearing age, understanding the unique risks of pregnancy to the mother and fetus and how to best provide clinical care for these women during pregnancy is imperative. However, there are limited clinical data to guide counseling and management in this population. This expert review offers an analysis of the literature about Fontan circulation during pregnancy and describes our center's current multidisciplinary approach to care for these women in the preconception, antepartum, intrapartum, and postpartum periods.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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