Abstract
A 30-year-old woman with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) treated with Takeuchi repair when she was one-month-old was referred to the obstetric department of our hospital for the management of her first pregnancy. She had a surgical operation for severe pulmonary regurgitation and tricuspid regurgitation one year before the pregnancy. The preoperative study showed a deterioration of right ventricular (RV) function, while presenting good performance of the left ventricle (LV). The cardiac function was found fully recovered through a postoperative study. A multidisciplinary medical team made close observations from the 3rd trimester to after the delivery. A successful vaginal delivery occurred at 39 gestational weeks with a completely healthy baby without any maternal cardiac events. The serum brain natriuretic peptide level did not elevate significantly during the pregnancy. The echocardiography showed that the LV ejection fraction, the LV internal dimension in diastole, and the global longitudinal strain (GLS) of LV remained in normal ranges. No significant valvar insufficiencies or stenoses were found. The GLS of the free wall of RV changed from −19.7% to −10.7% during the delivery and recovered to −23.8% one month after the delivery. Analogously, the fractional area change worsened from 58.3% to 25.4% and returned up to 57.1%. The tolerance of the cardiac load in pregnancy and delivery was ensured by the excellent postoperative course of ALCAPA with Takeuchi repair as well as the successful pulmonary and tricuspid valve reoperation in adulthood with fine assessment of the RV function.
