Pregnancy in a patient with the repaired common arterial trunk

Background: The common arterial trunk is a congenital cardiac defect (CCD), in which the only main vessel carrying mixed blood into the greater and lesser circulations originates from the heart. CCD refers to a cyanotic heart disease. The incidence of this pathology is 0.043 per 1,000 live births. As much as 75% of the infants with the common arterial trunk die in the first year of life; 65% of them do within the first six years. The cause of death is cardiac failure and blood overflow of the pulmonary vessels. The treatment is surgical. Hereafter, the patients with the common arterial trunk need to be followed up by a cardiologist and a cardiosurgeon throughout their life. During pregnancy, the maternal and fetal risks are determined by the existing CCDs and the severity of right ventricular outflow tract obstruction, arrhythmias, and cardiac failure. Maternal death during pregnancy in the presence of heart diseases is 0–1%, while cardiac failure complicates the course of pregnancy in 11% of cases. There are single reports on pregnancy and delivery in women with the repaired common arterial trunk.

Case report: A 32-year-old primigravida with the repaired common arterial trunk and repeated surgical interventions on the heart was for the first time admitted to an obstetric hospital at 30 weeks’ gestation for treating threatened premature birth and developing the tactics of management of pregnancy and delivery. Pregnancy occurred as a result of the first VF attempt. Heart function was evaluated over time on the basis of EchoCG data. Despite the increase in systolic pressure in the pulmonary artery (PA) to 55 mm Hg; the patient’s status was satisfactory: it corresponded to functional Class I according to the New York Heart Association (NYHA) Functional Classification and to functional maternal WHO (mWHO) according to the NYHA classification, it corresponded to Functional Class II–III according to the maternal WHO (mWHO) Risk Classification of Cardiovascular Complications during Pregnancy. She delivered via cesarean section at 34–35 weeks’ gestation due to the appearance of signs of fetal distress (a slow increase in fetometric indicators, oligohydramnios, and signs of central fetal blood flow).

Conclusion: Pregnancy is not contraindicated for women with the repaired common arterial trunk in the compensation for their status and in the absence of significant hemodynamic disorders and may progress without cardiological and obstetric complications. Multidisciplinary decision on the possibility of pregnancy, the tactics of its management and delivery depends on cardiac hemodynamic parameters, on the presence of obstetric complications and is taken on the basis of joint conclusions by a cardiologist, an obstetrician, and an аnesthetist. There are no strictly defined recommendations for pregnancy management for this or that cardiac defect, since the type of a defect and the stages of its surgical treatment make each case unique.