(Outcomes of pregnancy in pre-existing cardiomyopathy and after heart transplantation)

Introduction: Pregnancy in females with pre-existing cardiomyopathy with left-ventricular systolic dysfunction and/or after heart transplantation is associated with risks for both the mother and the child. Thus, it is not recommended in the majority of patients. However, in selected cases, with awareness of the risks, pregnancy may be considered. We aimed to analyse a group of patients with heart failure and/or after heart transplantation (HTx) who were pregnant and gave birth to a living new-born during follow-up in our institution. Methods: Patients were found in the clinical database of IKEM retrospectively. Clinical and para-clinical data were analysed. Results: Nine pregnancies in eight females with pre-existing cardiomyopathy were identified. Most patients had dilated cardiomyopathy (75%), their left-ventricular ejection fraction (LVEF) was normal or mildly reduced in 56%, moderately reduced in 22%, and severely reduced in 22%. Pregnancy was not recommended in females with severe left-ventricular history with death due to heart failure in her brother and necessity of HTx in her mother, which was subsequently diagnosed with Danon disease. During pregnancies with pre-existing cardiomyopathy and twelve months postpartum we recorded two episodes of decompensated heart failure, one episode of decompensated arterial hypertension and two transient ischemic attacks. Taken together, cardiovascular events complicated 55% of these pregnancies. We observed a decrease in LVEF >= 10% in 44% of pregnancies after one year. Subsequently, the female with Danon disease required HTx. There was no maternal death. In addition, we recorded four deliveries after HTx, which were except of one episode of preeclampsia uncomplicated and gave birth to four hypotrophic, but healthy babies. Median time from HTx to delivery was 68 months, subsequent period was uneventful, all four females are alive with a follow-up of 49-118 months after delivery. Conclusions: Contemporary therapeutic modalities of heart failure lead in most patients with dilated cardiomyopathy to at least temporary improvement of left-ventricular systolic function outside the range of severe systolic dysfunction, which enables in selected cases birth of living fetus. Pregnancy is possible also in highly selected females after HTx. However, due to their complicated biological situation and prognostic aspects, we do not recommend pregnancy in this