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- Open Access
Relationship between cardiac magnetic resonance imaging parameters and pregnancy outcomes in women post mustard repair: a multi-center study
© Juan et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Cardiovascular Magnetic Resonance
- Pregnancy Outcome
- Right Ventricle
- Obstetric Complication
- Cardiovascular Magnetic Resonance Imaging
Summary: To examine the relationship between cardiovascular magnetic resonance imaging (CMR) parameters and pregnancy outcomes post Mustard palliation.
Background: Impaired systemic ventricular function and presence of a systemic right ventricle (RV) are associated with adverse events in pregnancy. Women with transposition of the great arteries post atrial switch (Mustard procedure) are at risk of worsening arrhythmia and heart failure antenatally. Contemporary guidelines suggest that women with "more moderate systemic RV dysfunction" should be advised against pregnancy; however a threshold RV ejection fraction (EF) has not been defined as all studies to date have examined RV function using echocardiography alone. The CMR characteristics of women post Mustard palliation undergoing pregnancy and the relationship between CMR parameters and pregnancy outcomes have not yet been described.
A total of 17 consecutive women post Mustard procedure seen at 2 tertiary care centers who had undergone CMR within 2 years of pregnancy were included. Parameters of ventricular function were assessed by a single experienced reader using steady-state free-precession cine CMR acquired in the short-axis orientation. Adverse cardiovascular events (sustained arrhythmia, heart failure, stroke, cardiac arrest and/or urgent cardiac intervention), obstetric complications (eclampsia, pre-term labour, hemorrhage) and fetal/neonatal events (stillbirth/death, prematurity, low birthweight, intensive care unit admission) were recorded.
Summary of demographic characteristics and outcomes
Maternal demographic data
Age at Mustard palliation (years)
Age at delivery (years)
Age at CMR (years)
Gravida ≥ 3
Transposition of the great arteries with intact septum
Transposition of the great arteries with ventricular septal defect
Transposition of the great arteries with aortic coarctation
Cardiovascular events in pregnancy
Decline in NYHA classification
Sustained tachyarrhythmia resulting in heart failure
Premature rupture of membranes
Premature delivery < 37 weeks
Admission to intensive care unit
*events not mutually exclusive
Impaired RVEF, specifically RVEF <35% as determined by CMR, may be useful for stratification of risk for pregnancy-related cardiovascular complications in women post Mustard palliation. These preliminary findings require validation in a larger cohort of patients.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.