Abstract
Patients with the Fontan operation have a unique circulation, with a limited ability
to increase cardiac output, and high central venous pressure. They may have diastolic
and/or systolic ventricular dysfunction, arrhythmias, thromboembolic complications,
or multiorgan dysfunction. All of these factors contribute to reproductive issues,
including menstrual irregularities, infertility, recurrent miscarriage, and complications
during pregnancy. Although atrial arrhythmias are the most common cardiac complications
during pregnancy, patients can develop heart failure and thromboembolic events. Obstetric
bleeding, including postpartum hemorrhage, is common. In addition to maternal complications,
adverse fetal and neonatal events, such as prematurity and low birthweight, are very
common. Counselling about these reproductive issues should begin early. For those
who become pregnant, care should be provided by a multidisciplinary cardio-obstetric
team familiar with the specific issues and needs of the Fontan population. In this
review, we discuss infertility, contraception, and pregnancy in patients with the
Fontan operation.
Résumé
L’intervention de Fontan crée un schéma circulatoire unique se traduisant par une
capacité limitée d’augmentation du débit cardiaque et une pression veineuse centrale
élevée. Les patients qui ont subi cette intervention peuvent présenter une dysfonction
ventriculaire diastolique et/ou systolique, des arythmies, des complications thromboemboliques
ou une dysfonction multiviscérale. Tous ces facteurs contribuent à des problèmes de
reproduction, notamment des irrégularités menstruelles, l’infertilité, des fausses
couches répétées et des complications obstétricales. Les arythmies atriales sont les
complications cardiaques les plus courantes pendant la grossesse, mais une insuffisance
cardiaque et des événements thromboemboliques peuvent aussi survenir. Les saignements
obstétricaux, dont l’hémorragie post-partum, sont fréquents. Outre les complications
chez la mère, on note une fréquence élevée d’événements indésirables touchant le fœtus
et le nouveau-né, tels que la prématurité et l’insuffisance pondérale à la naissance.
Le counseling sur ces questions touchant la reproduction devrait commencer tôt. Les
femmes enceintes devraient être prises en charge par une équipe cardio-obstétricale
bien au fait des difficultés et des besoins spécifiques des patientes qui ont subi
l’intervention de Fontan. Dans cet article de synthèse, nous abordons l’infertilité,
la contraception et la grossesse chez les patientes ayant subi l’intervention de Fontan.
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Article Info
Publication History
Published online: April 28, 2022
Accepted:
April 25,
2022
Received:
March 4,
2022
Footnotes
See page 927 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
