What does this research mean for the field?

Pregnancy in patients with Fontan physiology is feasible but carries high risks of complications such as preterm delivery and bleeding, requiring specialized multidisciplinary cardio-obstetric care. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 24, 2025JACC Case ReportsOpen Access

Cardio-Obstetric Care in a Patient With Tricuspid Atresia and Fenestrated Fontan

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Why the study?

Pregnancy in patients with congenital heart disease, particularly those with Fontan physiology, presents significant risks for both mother and fetus.

Does intensive multidisciplinary cardio-obstetric care allow for successful pregnancy and delivery in a high-risk patient with Fontan physiology?

Structured PICO

Does intensive multidisciplinary cardio-obstetric care allow for successful pregnancy and delivery in a high-risk patient with Fontan physiology?

Population

26-year-old gravida 1, para 0 (G1P0) woman (n=1) with a history of tricuspid atresia, moderate-sized ventricular septal defect, and subpulmonary/pulmonary valve stenosis, palliated with a bidirectional Glenn and modified fenestrated lateral tunnel Fontan at 3 years of age. Has stable Fontan-associated liver disease with stage III to IV fibrosis.

Intervention

Intensive multidisciplinary cardio-obstetrics care including monthly follow-ups, serial echocardiography, dynamic anticoagulation management (enoxaparin, intravenous heparin, warfarin), and emergent multidisciplinary caesarean section delivery.

Outcome

Maternal and fetal clinical course, delivery outcome, and postpartum complications.

Pregnancy in patients with Fontan physiology is possible with meticulous multidisciplinary care, but carries extreme risks of thrombosis, bleeding, preterm delivery, and long-term maternal functional decline requiring transplantation.

Discussion

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Implication

Supports multidisciplinary cardio-obstetrics care in Fontan pregnancies; leaves open optimal risk mitigation strategies.

Cite This Study

Massad et al. (2025) studied this question.

synapsesocial.com/papers/6a10982e8090e499da61679b https://doi.org/10.1016/j.jaccas.2025.106041

Topics

Congenital heart disease adults

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Cardio-Obstetric Care in a Patient With Tricuspid Atresia and Fenestrated Fontan

Structured PICO

Discussion

Implication

Cite This Study

Topics

Cardio-Obstetric Care in a Patient With Tricuspid Atresia and Fenestrated Fontan

Structured PICO

Discussion

Implication

Cite This Study

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Topics

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