Purpose

Patients with single ventricle anatomy palliated with Fontan operation are at risk for thromboembolism, arrhythmia, and heart failure rendering pregnancy high risk or even contraindicated. Infertility and high rates of first trimester miscarriage are not uncommon. In vitro fertilization (IVF) with or without gestational surrogacy can be an option, but poses risks during ovarian stimulation, oocyte retrieval, and the post-procedural period. We present six cases of women with complex congenital heart disease status post Fontan operation who underwent successful IVF.

Methods

Case series from a single-center tertiary care setting.

Results

Indications for referral were cardiac or fertility concerns for pregnancy of the congenital cardiologist. One woman had mild volume overload after oocyte retrieval requiring furosemide and one experienced post-operative colitis. There were no thrombotic complications.

Conclusions

A multidisciplinary team-based approach can result in successful oocyte retrieval and IVF in women with complex congenital heart disease and Fontan physiology.

中文翻译：

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Fontan 生理学女性体外受精成功

目的

单心室解剖经 Fontan 手术姑息治疗的患者有血栓栓塞、心律失常和心力衰竭的风险，使妊娠风险高甚至禁忌。不孕不育和孕早期流产率高并不少见。有或没有妊娠代孕的体外受精 (IVF) 可以是一种选择，但在卵巢刺激、取卵和手术后阶段会带来风险。我们介绍了 Fontan 手术后患有复杂先天性心脏病的 6 例成功接受试管婴儿的女性病例。

方法

来自单中心三级医疗机构的病例系列。

结果

转诊的指征是先天性心脏病专家怀孕的心脏或生育问题。一名妇女在需要呋塞米的取卵后出现轻度容量超负荷，一名妇女经历了术后结肠炎。无血栓并发症。

结论

基于多学科团队的方法可以为患有复杂先天性心脏病和 Fontan 生理学的女性成功取卵和体外受精。