Pregnancy in a Fontan Patient: New Horizons in Medical and Surgical Fontan...
▶Ep 7 · 0:36
quoteSo this is a case of a 21-year-old woman who was born to tricuspiddoresia, a large ventricular septal defect, detransposition of the great arteries, and a severe lung segment aortic coagation.↗
▶Ep 7 · 0:46
clinicalThe patient underwent coarctation repair and PA banding at 2 days of life via end-to-end anastomotic repair after resection of coarc segment, plus left carotid to left subclavian artery side-to-side anastomosis↗
▶Ep 7 · 1:00
clinicalThe patient underwent right modified Blalock-Thomas-Taussig shunt at 6 weeks of age, bidirectional Glenn at 6 months, and 20mm extracardiac Fontan at 4 years of age↗
▶Ep 7 · 1:12
clinicalThe Fontan fenestration spontaneously closed and patient had transcatheter coil and vascular plugging of veno-venous collaterals at approximately 10 years of age↗
▶Ep 7 · 1:22
clinicalOn 2006 catheterization, Fontan pressures were 12 mmHg and left ventricular end-diastolic pressure was 5 mmHg, both normal↗
▶Ep 7 · 1:41
quoteShe was then lost to follow up from age 16 to 21 years of age until she presented pregnant in her first trimester, to an outside adult cardiologist.↗
▶Ep 7 · 1:41
clinicalPatient was lost to follow-up from age 16 to 21 years until presenting pregnant in first trimester↗
▶Ep 7 · 1:49
guidelineLisinopril is teratogenic and should be stopped in pregnancy↗
▶Ep 7 · 1:58
clinicalPatient had 3 prior miscarriages and was told to use Depo-Provera contraception but only had 1 injection in past 3-4 years↗
▶Ep 7 · 2:08
clinicalPatient had baseline NYHA class 2-3 dyspneic symptoms (short of breath climbing one flight of stairs or walking 2 blocks) with no change during first couple trimesters of pregnancy↗
▶Ep 7 · 2:21
quoteShe had repeatedly expressed concern about a higher peripartum mortality via vaginal delivery, and this was obtained through a variety of internet browsing readings.↗
▶Ep 7 · 2:39
clinicalPatient's oxygen saturation was low-normal at 92% on room air↗
▶Ep 7 · 3:20
clinicalEchocardiogram showed mildly reduced left ventricular systolic function with estimated LVEF 45-50%↗
▶Ep 7 · 4:20
clinicalPatient had mild polycythemia with hemoglobin of 17, indicative of probable intermittent desaturations likely from venous collaterals↗
▶Ep 7 · 4:43
clinicalPatient was classified as WHO class 3 risk, indicating significantly elevated risk of both maternal morbidity and mortality during peripartum period↗
▶Ep 7 · 4:43
quoteWe deemed her a WHO class 3 risk, uh, given the uh WHO risk stratification as she is a, a complex Fontan patient, which indicates that she has a significantly elevated risk of both maternal morbidity and mortality during the peripartum period and the remainder of pregnancy.↗
▶Ep 7 · 5:06
clinicalManagement included aspirin 162 mg daily; stronger anticoagulation not pursued given unremarkable thrombophilia profile↗
▶Ep 7 · 5:18
clinicalBeta blocker was considered if LV function remained depressed on subsequent visits↗
