Cardiology>>>>>Adult Congenital Heart Disease and Pregnancy
Question 27#

A 9-year-old woman was born with transposition of the great arteries and had a Mustard repair. She has been well throughout her pregnancy, but presents at 37 weeks with a week of worsening dull central chest pain on exertion, associated with shortness of breath. 

Which one of the following statements is false?

A. The woman is probably suffering from coronary insufficiency because the hypertrophied right ventricle only has a single-vessel blood supply
B. This is an acute coronary syndrome in pregnancy, which may be a dissection; the patient should go to the catheterization laboratory
C. The patient should be treated with bed rest and antianginals
D. The patient should be induced if the cervix is favourable
E. The baby should be delivered

Correct Answer is B

Comment:

Congenital heart disease affects 0.8% of live births and 85% of patients now survive to adulthood. Approximately 70% patients seen in cardiac antenatal clinics are those with congenital heart disease. Patients with atrial switch repair of transposition of the great arteries have a single right ventricle, which does not cope well with the demands of pregnancy. Coronary insufficiency can occur because of a mismatch between myocardial oxygen supply and demand. Short-term conservative treatment is acceptable but delivery should be expedited if possible, and certainly at 37 weeks gestation.