Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-26T22:53:19.988Z Has data issue: false hasContentIssue false
  • English
  • Français

Paediatric-onset coronary artery anomalies in pregnancy: a single-centre experience and systematic literature review

Published online by Cambridge University Press:  17 April 2017

Michelle Keir ,
Catriona Bhagra ,
Debra Vatenmakher ,
Francisca Arancibia-Galilea ,
Katrijn Jansen ,
Norihisa Toh ,
Candice K. Silversides ,
Jack Colman ,
Samuel C. Siu  and
Mathew Sermer
...Show all authors
Michelle Keir
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Catriona Bhagra
Affiliation:
Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada
Debra Vatenmakher
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Francisca Arancibia-Galilea
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Katrijn Jansen
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Norihisa Toh
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
Candice K. Silversides
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada
Jack Colman
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada
Samuel C. Siu
Affiliation:
Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada Division of Cardiology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
Mathew Sermer
Affiliation:
Division of Obstetrics, Mount Sinai Hospital, University of Toronto, Toronto
Andrew M. Crean
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada
Rachel M. Wald*
Affiliation:
Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, Toronto, Ontario, Canada
*
Correspondence to: R. M. Wald, Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, 585 University Avenue, 5N 517, Toronto, Ontario, Canada, M5G 2N2. Tel: +416 340 5502; Fax: +416 340 5014; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Individuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population.

Methods

We performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death.

Results

A total of 25 surveys were mailed, and 20 were returned (80% response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59% of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23%, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18%, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14%) and included heart failure (n=5, 5%), myocardial infarction (n=7, 7%), maternal death (n=2, 2%), cardiac arrest secondary to ventricular fibrillation (n=1, 1%), and stroke (n=1, 1%). The majority of maternal events (13/14, 93%) occurred in women with no previous diagnosis of coronary disease.

Conclusions

Women with paediatric-onset coronary artery anomalies have a 14% risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.

Keywords

Congenital coronary anomaliesanomalous aortic origin of a coronary arteryanomalous left coronary artery from the pulmonary arteryKawasaki diseasepregnancy outcomes
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1529 - 1537
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Grewal, J, Silversides, CK, Colman, JM. Pregnancy in women with heart disease: risk assessment and management of heart failure. Heart Failure Clin 2014; 10: 117–129.Google Scholar
2. Akpinar, I, Sayin, M, Karabag, T, et al. Differences in sex, angiographic frequency, and parameters in patients with coronary artery anomalies: single-center screening of 25368 patients by coronary angiography. Coron Artery Dis 2013; 24: 266–271.CrossRefGoogle Scholar
3. Ripley, D, Saha, A, Teis, A, et al. The distribution and prognosis of anomalous coronary arteries identified by cardiovascular magnetic resonance: 15 year experience from two tertiary centres. J Cardiovasc Magn Reson 2014; 16: 1–8.Google Scholar
4. Rajbanshi, BG, Burkhart, HM, Schaff, HV, Daly, RC, Phillips, SD, Dearani, JD. Surgical strategies for anomalous origin of coronary artery from pulmonary artery in adults. Congit Heart Dis 2014; 148: 220–224.Google Scholar
5. Sharma, V, Burkhart, HM, Dearani, JD, et al. Surgical unroofing of anomalous aortic origin of a coronary artery: a single-center experience. Ann Thorac Surg 2014; 98: 941–946.Google Scholar
6. Kato, H. Cardiovascular complications in Kawasaki disease: coronary artery lumen and long-term consequences. Progress Pediatr Cardiol 2004; 19: 137–145.Google Scholar
7. Holmes, A, Laney, D. A retrospective survey studying the impact of Fabry disease on pregnancy. JIMD Rep 2015; 21: 57–63.Google Scholar
8. Siu, SC, Sermer, M, Colman, JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104: 515–521.CrossRefGoogle ScholarPubMed
9. Cauldwell, M, Swan, L, von Klemperer, K, Patel, R, Steer, P. Management of ALCAPA in two pregnancies. Int J Cardiol 2015; 181: 353–354.Google Scholar
10. Kanno, K, Sakai, H, Nakajima, M, Satake, A, Konishi, T, Hajime, I. An adult case of Kawasaki disease in a pregnant Japanese woman: a case report. Case Rep Dermatol 2011; 3: 98–102.Google Scholar
11. McAndrew, P, Hughes, D, Adams, P. Pregnancy and Kawasaki disease. Int J Obstet Anesth 2000; 9: 279–281.Google Scholar
12. Gordon, CT, Jimenez-Fernandez, S, Daniels, LB, et al. Pregnancy in women with a history of Kawasaki disease: management and outcomes. BJOG 2014; 121: 1431–1438.Google Scholar
13. Youssef, A, Ben Amara, F, M’barki, M, Reziga, H, Magherbi, H, Neji, K. Grossesse et accrouchement associée a une insuffisance coronarienne due a une maladie de Kawaski. Tunise Med 2013; 91: 217–218.Google Scholar
14. Roscani, MG, Zanati, SG, Salmazo, PS, et al. Congenital aneurysmal circumflex coronary artery fistula in a pregnant woman. Clinics 2012; 67: 1523–1525.Google Scholar
15. Wanczura, P, Orlowski, M, Stecko, W, et al. Niedomykalnosc zastawki mitralnej w przebiegu zespolu Blanda-White’a-Garlanda u chorej po czterech neipowiklanych porodach fizjolgicznych. Pol Merkur Lekarski 2011; 31: 103–105.Google Scholar
16. Samada, K, Shiraishi, H, Sato, A, Momoi, MY. Grown-up Kawasaki disease patients who have giant coronary aneurysms. World J Pediatr 2010; 6: 38–42.Google Scholar
17. Lazar, D, Enriquez, LJ, Rozental, T. Anomalous origin of the left coronary artery from the pulmonary artery in a pregnant woman with preeclampsia. J Cardiothorac Vasc Anesth 2010; 24: 112–115.CrossRefGoogle Scholar
18. Radomska, E, Polewyczyk, A, Sadowski, M, Janion, M. Acute myocardial infarction due to thrombosis of coronary artery aneurysm in a 29-year-old women during postpartum period. Kardiol Pol 2008; 66: 1302–1305.Google Scholar
19. Wojciuk, J, Bury, RW, Roberts, DH. Large bilateral coronary artery fistulae. Int J Cardiol 2008; 128: e93–e94.Google Scholar
20. Hibbard, JU, Fajardo, JE, Briller, J. Kawasaki disease with coronary artery sequelae. Obstet Gynecol 2007; 109: 517–519.Google Scholar
21. Lee, AC, Foster, E, Yeghiazarians, Y. Anomalous origin of the left coronary artery from the pulmonary artery: a case series and brief review. Congenit Heart Dis 2006; 1: 111–115.Google Scholar
22. Adamo, L, Adamo, M. Giant single coronary artery with terminal fistulous aneurysm: a rare entity. Heart 2006; 92: 1419.Google Scholar
23. Choong, CK, Martinez, C, Barner, HB, Ludbrook, PA. Bland-White-Garland syndrome in pregnancy: reoperation of ALCAPA with an internal thoracic radial artery “Y”-graft. Ann Thorac Surg 2006; 81: 1512–1514.Google Scholar
24. Tsuda, E, Kawamata, K, Neki, R, Echigo, S, Chiba, Y. Nationwide survey of pregnancy and delivery in patients with coronary arterial lesions caused by Kawasaki disease in Japan. Cardiol Young 2006; 16: 173–178.Google Scholar
25. Tsuda, E, Ishihara, Y, Kawamata, K, et al. Pregnancy and delivery in patients with coronary artery lesions caused by Kawasaki disease. Heart 2005; 91: 1481–1482.CrossRefGoogle ScholarPubMed
26. Zavalloni, D, Belli, G, Caratti, A, Presbitero, P. Anomalous origin of the left coronary artery from the pulmonary artery in an adult pregnant patient: surgical and percutaneous myocardial revascularization. Ital Heart J 2005; 6: 348–352.Google Scholar
27. Brown, B, Xie, GY, Booth, D. Images in cardiology: multiple coronary fistulae. Clin Cardiol 2005; 28: 143.Google Scholar
28. Maeder, M, Vogt, PR, Ammann, P, Rickli, H. Bland-White-Garland syndrome in a 39-year-old mother. Ann Thorac Surg 2004; 78: 1451–1453.Google Scholar
29. Tay, SM, Ong, BC, Tan, SA. Cesarean section in a mother with uncorrected congenital coronary to pulmonary artery fistula. Can J Anesth 1999; 46: 368–371.Google Scholar
30. Shear, R, Leduc, L. Successful pregnancy following Kawasaki disease. Obstet Gynecol 1999; 94: 841.Google Scholar
31. Nightingale, AK, Burrell, CJ, Marshall, AJ. Anomalous origin of the left coronary artery from the pulmonary artery: natural history and normal pregnancies. Heart 1998; 80: 629–631.Google Scholar
32. Hayakawa, H, Katoh, T. Successful pregnancy after coronary artery bypass grafting for Kawasaki disease. Acta Paediatr Jpn 1998; 40: 275–277.Google Scholar
33. Espinosa, R, Badui, E, Rangel, A. A case of a coronary artery arising from the pulmonary artery. Rev Invest Clin 1997; 49: 225–226.Google Scholar
34. Daniels, C, Bacon, J, Fontana, ME, Eaton, G, Cohen, D, Leier, CV. Anomalous origin of the left main coronary artery from the pulmonary trunk masquerading as peripartum cardiomyopathy. Am J Cardiol 1997; 79: 1307–1308.Google Scholar
35. Arakawa, K, Akita, T, Nizhizawa, K, et al. Anticoagulant therapy during successful pregnancy and delivery in a Kawasaki disease patient with coronary aneurysm: a case report. Jpn Circ J 1997; 61: 197–200.Google Scholar
36. Sbraggia, P, Habib, G, Garcia, M, et al. Naissance anormale de la coronaire gauche a partir de l’artère pulmonaire: apport diagnostique des techniques échographiques. Ann Cardiol Angéiol 1996; 45: 507–511.Google Scholar
37. Alam, S, Sakura, S, Kosaka, Y. Anaesthetic management for Caesarean section in a patient with Kawasaki disease. Can J Anaesth 1995; 42: 1024–1026.Google Scholar
38. Ruszkiewicz, A, Opeskin, K. Sudden death in pregnancy from congenital malformation of the coronary arteries. Pathology 1993; 25: 236–239.Google Scholar
39. Puppo, A, Fournier, JA, Leal, R, et al. Infarto agudo de miocardio y aneurisma arterial coronario durante el embarazo. Rev Esp Cardiol 1993; 46: 47–48.Google Scholar
40. Nolan, TE, Savage, RW. Peripartum myocardial infarction from presumed Kawasaki’s disease. South Med J 1990; 83: 1360–1361.CrossRefGoogle ScholarPubMed
41. Goldberg, N, Zisbrod, Z, Kipperman, R, et al. Congenital aneurysm of the left coronary sinus and left main coronary artery with fistulous communication to the right atrium in pregnancy. J Am Soc Echocardiogr 1990; 3: 125–130.Google Scholar
42. Suarez Ortega, S, Franco Cebrian, J, Medina Fernandez-Aceytuno, A, Armas Portela, M, Mendez Mora, D, Zarazaga, E. Infarto de miocardio no arteriosclerotico en enferma de 24 anos y uso accidental de amiodarona durante el embarazo sin efectos embriotoxicos. Med Clin (Barc) 1988; 90: 586–588.Google Scholar
43. Chestnut, DH, Roberts, SL, Laube, DW, Martins, JB. Pregnancy in a patient with aneurysms of the right coronary artery and an arterioventricular fistula: a case report. J Reprod Med 1986; 31: 528–530.Google Scholar
44. Klein, VR, Repke, JT, Marquette, GP, Niebyl, JR. The Bland-White-Garland syndrome in pregnancy. Am J Obset Gyencol 1984; 150: 106–107.Google Scholar
45. Sabharwal, MS, Tak, J, Chatterjee, S, et al. Anomalous left coronary artery arising from the pulmonary artery in a 38-year pregnant female. J Am Med Assoc 2015; 65: A635.Google Scholar
46. Holliday, L, Misenheimer, J, Sharma, G. Peripartum diagnosis and management of coronary arterial fistula. J Am Med Assoc 2015; 65: A582.Google Scholar
47. Juraszek, A, Drohomirecka, A, Kolsut, P, et al. Takeuchi’s repair in adult women with Bland-White-Garland syndrome and silent myocardial ischemia. Eur Surg 2014; 46: S23–S24.Google Scholar
48. Ganigara, M, Collins, N, Tanous, D, Clermajer, D, Puranik, R. Anomalous left anterior descending coronary artery from the pulmonary artery – the role of cardiac MRI. Int J Cardiol 2014; 172: e172–e174.Google Scholar
49. Ginghina, C, Popescu, BA, Craciunescu, I, et al. Associated coronary artery anomalies: a diagnostic and therapeutic challenge. Arch Balk Med Un 2006; 41: 132–134.Google Scholar
50. Taniguchi, K, Ono, H, Sato, A, et al. Strict management of a pregnant patient with giant coronary aneurysm due to Kawasaki disease. Pediatr Int 2015; 57: 990–992.Google Scholar
51. Bruckheimer, E, Bulbul, Z, McCarthy, P, Madri, JA, Friedman, AH, Hellenbrand, WE. Kawasaki disease: coronary aneurysms in mother and son. Circulation 1998; 97: 410–411.Google Scholar
52. Simsek, H, Tuncer, M, Yaman, M, Celik, M. Presentation of adult Bland-White-Garland syndrome in a 32-year-old female. Int J Cardiovasc Acad 2015; 1: 56–58.Google Scholar
53. Patel, H, Swirsky, B. Alcapa syndrome: a rare congenital anomaly diagnosed postpregnancy in an adult. Chest 2015; 148: 37A.Google Scholar
54. Saaid, R, Balchin, I, Azman, W. Coronary artery fistula in pregnancy. J Obstet Gynaecol Res 2015; 41: 51–52.Google Scholar
55. Burchill, LJ, Lameijer, H, Roos-Hesselink, JW, et al. Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome. Heart 2015; 101: 525–529.CrossRefGoogle ScholarPubMed
56. Chang, AM, Mumma, B, Sease, KL, Robey, JL, Shofer, FS, Hollander, JE. Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk. Acad Emerg Med 2007; 14: 599–605.Google Scholar
57. Henderson, JT, Whitlock, EP, O’Connor, E, Senger, CA, Thompson, JH, Rowland, MG. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 160: 695–703.Google Scholar
58. Newburger, JW, Takahashi, M, Gerber, MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis, and Kawasaki disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004; 114: 1708–1733.Google Scholar
59. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol 2008; 52: e143–e263.Google Scholar
60. Newport, DJ, Brennan, PA, Green, P, et al. Maternal depression and medication exposure during pregnancy: comparison of maternal retrospective recall to prospective documentation. BJOG 2008; 115: 681–688.Google Scholar
61. Davies, JE, Burkhart, HM, Dearani, JA, et al. Surgical management of anomalous aortic origin of a coronary artery. Ann Thorac Surg 2009; 89: 844–847.Google Scholar
62. Angelini, P. Coronary fistulae: which ones deserve treatment and what kind of treatment do they need? Tex Heart Inst J 2007; 34: 202–203.Google Scholar
Supplementary material: File

Keir supplementary material

Keir supplementary material

Download Keir supplementary material(File)
File 31.2 KB