# Pregnancy-Related Cardiac Adaptation and Postpartum Echocardiographic Findings in Repaired Tetralogy of Fallot: A Study Integrated with ESC 2025 Recommendations

## TL;DR

This study examines how women with repaired Tetralogy of Fallot manage pregnancy and how their heart function changes before and after childbirth, following ESC guidelines.

## Contribution

The study provides insights into cardiac adaptation during pregnancy and postpartum in women with repaired ToF, aligned with the 2025 ESC recommendations.

## Key findings

- Pregnancy was generally well-tolerated with preserved ejection fraction and stable right ventricular function.
- Postpartum echocardiographic assessments showed no deterioration in ventricular function or valvular regurgitation.
- Early postpartum echocardiography may help identify functional changes and guide long-term follow-up.

## Abstract

Background and Objectives: To evaluate pregnancy outcomes and transthoracic echocardiographic (TTE) findings during the antenatal and postpartum periods in women with repaired Tetralogy of Fallot (ToF) who delivered at Çukurova University Faculty of Medicine, Balcalı Hospital, between 2011 and 2025 and to interpret these findings in the context of the 2025 European Society of Cardiology (ESC) recommendations. Materials and Methods: This single-center retrospective cohort study undertaken between 2011 and 2025 included 11 pregnant women with surgically repaired ToF. Maternal demographic characteristics, obstetric outcomes, mode of delivery, neonatal outcomes, and antenatal TTE parameters were recorded. Cardiac measurements obtained during pregnancy were compared with postpartum TTE findings performed 3–6 months after delivery to assess pregnancy-related cardiac adaptation and recovery. Results: A total of 11 pregnancies in women with repaired ToF were analyzed. Nine pregnancies resulted in live births, while one ended in missed abortion at 9 + 2 weeks and one in intrauterine fetal demise at 34 + 2 weeks. Among live births, the mean gestational age was 36 + 2 weeks and the mean birthweight was 2865 g, with a preterm delivery rate of 55.6%. Cesarean section was performed in 70% of cases, while 30% delivered vaginally. During pregnancy, the mean left ventricular ejection fraction was 62.6%, and residual tricuspid regurgitation was the most frequently observed echocardiographic finding. Postpartum TTE evaluations indicated that echocardiographic parameters were largely stable over the observation period, with no numerical change and no clear evidence of deterioration in ventricular function or progression of valvular regurgitation. Conclusions: Despite successful surgical repair, pregnancy may still pose potential risks for women with ToF, underscoring the importance of individualized, multidisciplinary management. In this cohort, pregnancy appeared to be generally well-tolerated when care was provided in accordance with contemporary ESC recommendations. The observation of preserved ejection fraction and overall stable right ventricular function in the early postpartum period suggests that favorable maternal cardiac adaptation may be achievable in carefully selected patients. Early postpartum echocardiographic assessment may be useful for identifying functional changes and informing structured long-term follow-up strategies.