Arterial Transposition Correction Reduces Pregnancy Risk

Women who had an arterial switch procedure to correct transposition of the great arteries (TGA) tolerated pregnancy well with few complications, according to a new study.

Researchers at Erasmus University Medical Center (Rotterdam, The Netherlands), the German Centre for Cardiovascular Research (DZHK; Berlin, Germany), and other institutions conducted a study involving 41 pregnant women (mean age 26.7 years) who underwent a prior arterial switch procedure for TGA. The primary end point was a major adverse cardiovascular event (MACE), defined as maternal death, supraventricular or ventricular arrhythmias, heart failure, aortic dissection, endocarditis, ischemic coronary events, and thromboembolic events.

The results showed that none of the women died during pregnancy or up to six months after delivery, and only two women (4.9%) suffered a MACE event, with one woman experiencing heart failure and the other developing ventricular tachycardia during the second and third trimesters, which was effectively treated with metoprolol. No deterioration in left or right ventricular function during pregnancy was evidenced. The median gestational age at delivery was 39 weeks and mean birth weight was 2,962 grams. Only one women suffered fetal loss. The study was published on December 22, 2020, in Journal of the American Heart Association.

“During the past 30 years, the arterial switch procedure has replaced the atrial switch procedure to correct TGA. Many cardiologists are reluctant to give green light for pregnancy in these cardiac patients, but our study proves that pregnancy is relatively safe,” said senior author Julien Roos-Hesselink, MD, of Erasmus University Medical Center. “In my opinion, it is also very important to let women lead a normal life, including pregnancy and starting a family.”

TGA arteries is a cyanotic congenital heart defect (CHD) in which the aorta and the pulmonary artery are reversed (transposed), with the aorta arising from the right ventricle and the pulmonary artery from the left. This switch causes deoxygenated blood from the right heart to be pumped immediately through the aorta and circulated throughout the body and the heart itself, bypassing the lungs altogether. At the same time, the left heart continuously pumps oxygenated blood back to the lungs via the pulmonary artery, instead of out into the body's circulation as it normally would.

Related Links:
Erasmus University Medical Center
German Centre for Cardiovascular Research