Pregnancy Outcomes in Women With Fontan Circulation: Single Tertiary Center Experience

Abstract

Background and Objectives: The Fontan operation is a significant advancement in the palliative treatment of patients with single ventricular physiology. However, pregnancy in women with Fontan circulation presents increased risks for both the mother and fetus, with limited data available on maternal and fetal outcomes. This study reports maternal and fetal outcomes of pregnancies in women with Fontan circulation from a single tertiary center. Methods: This retrospective study included all pregnant patients with Fontan physiology treated at Seoul National University Hospital from June 1986 to September 2023. The cases reviewed encompassed miscarriages, premature births, and full-term deliveries. Results: Eight patients underwent 15 pregnancies. The mean age at first pregnancy was 26.7 years. There were 7 live births (46.7%) and 8 miscarriages (53.3%), including 1 therapeutic miscarriage. The average age at first delivery was 28 years and the mean gestational age was 36 +/- 2.5 weeks. Out of 7 live births, 2 (28.6%) were premature births. For delivery, 6 (85.7%) underwent cesarean section. All pregnancies were monitored with echocardiography. Aspirin was administered as an antithrombotic medication in 5 patients (62.5%), and 2 patients (25%) was on warfarin prior to pregnancy. Two patients (28.6%) experienced postpartum cardiac complications (transient heart failure and thromboembolism, respectively), which were successfully managed. Conclusions: We observed a 46.7% success rate of live births among pregnant women with Fontan circulation. Although 2 pregnancies had cardiac complications, there was no severe morbidity and mortality. Thus, pregnancy and planned delivery are feasible in selected women with Fontan circulation under close monitoring.