REPRODUCTION AND SURVIVAL AFTER CARDIAC DEFECT REPAIR

In the last 25 years, surgical advances have led to correction of
congenital heart defects (CHD) in children who otherwise would
not have lived to adulthood. This study has two major
objectives: 1) to determine mortality, morbidity (reoperation,
arrhythmias, endocarditis), and disability after repair of CHD,
and the major risk factors which predict these events; and 2) to
assess the safety of pregnancy to women with corrected CHD,
and the risk of prematurity and recurrence of CHD in offspring. This study would create a registry comprised of all Oregon
children undergoing surgical repair of CHD and would study the
eight most prevalent defects: ventricular septal defect (VSD),
atrial septal defect (ASD), pulmonic stenosis (PS), tetralogy of
Fallot (TOF), coarctation of the aorta, aortic stenosis (AS),
transposition of the great arteries (TGA), and patent ductus
arteriosus (PDA). This proposal is an extension of an identical
project complied by the investigators for TOF (N=310), VSD
(N=217), and ASD (N=287). 87% of all subjects were successfully
followed with a median of 9 years of observation; more than 85
subjects have been followed for more than 20 years. All cases of surgical correction of PS, AS, TGA, PDA and
coarctation performed in children age 18 or younger in Oregon
from 1958 to 1981 will be added to the registry. Preoperative,
operative and postoperative data for each patient will be entered
into the data base at chart review. Follow-up for each patient
will be gathered by mailed questionnaire, telephone survey, and
the National Death Index. Questionnaires will assess major
morbidity, functional status and reproduction; pregnancy and
major events will be confirmed from physician's records.
Follow-up for TOF, VSD and ASD will be conducted in years 1, 3
and 5 and for TGA, AS, PS, PDA and coarctation in years 2 and
4. Chart review will be completed in year 2, and cases will then
be prospectively identified. Actuarial analysis and the Cox proportional hazards model will
determine mortality, major morbidity and their risk factors.
Reproductive data will be analyzed per years of fertility for the
cohort, and compared to Oregon population statistics. This study will add knowledge of late survival and morbidity of a
population which is rapidly growing in size, adults with corrected
CHD. Additionally, we will gather the first prospective
population data on pregnancy and outcome after repair of CHD;
this is vital as more adults than ever before with CHD are of
child-bearing age.