Australian and New Zealand Journal of Obstetrics and Gynaecology 2005; 45: 243–247 243 Blackwell Publishing, Ltd. Case Series Pregnancy and the Rastelli operation Pregnancy and the Rastelli operation Dorothy J. RADFORD and Gregory STAFFORD The Prince Charles Hospital, Brisbane, Australia Abstract Background: The aim of surgical correction of congenital heart disease is for the patient to live a relatively normal life, including potential pregnancy and childbirth. The Rastelli repair operation using a valved conduit for certain complex congenital heart lesions has resulted in survival into adult life. Aims: We reviewed reproductive outcome of 22 women over 18 years of age who were survivors of the Rastelli operation performed between 1977 and 1999. Results: Six women had a total of 12 pregnancies with six live births. Three women, with complex transposition of the great arteries, developed more severe subaortic obstruction during pregnancy. All required further heart surgery. Delivery was by Caesarean section in three patients and vaginally in the other three. All infants were healthy and free from defects. Two women had tubal ligations because of their cardiac problems. Conclusions: Women who have had Rastelli repair operation for complex congenital heart disease can have successful pregnancies. Subaortic stenosis can become a problem and should ideally be eliminated before pregnancy. Because of multiple operations, complications and genetic concerns, some women choose not to reproduce. Careful cardiac evaluation before, during and after pregnancy is essential. Key words: congenital heart disease, pregnancy, Rastelli operation, subaortic stenosis, truncus arteriosus. Introduction With major advances in heart surgery, many more children with congenital heart disease are surviving into adult life. In 1940 the survival rate was just 20%, in 1980 it was 70%, and now it is 85% or more. 1,2 These young adult survivors expect to live as normal a life as possible. Thus, pregnancy manage- ment in such patients becomes an important consideration. Rastelli described techniques to repair previously untreat- able lesions including truncus arteriosus, 3,4 transposition of the great arteries with ventricular septal defect and pulmo- nary stenosis, 5 and pulmonary atresia with ventricular septal defect. 6 Additional complex lesions such as double outlet right ventricle, and congenitally corrected transposition with ventricular septal defect and pulmonary stenosis has been repaired by the same technique. 7 The repair involves a homo- graft valved conduit to connect right ventricle to pulmonary artery, as well as an intracardiac patch repair of the ventricular septal defect, directing left ventricular blood to the aorta. 1 (Fig. 1) Since world experience of pregnancy following the Rastelli operation is small, 8–13 we reviewed our results. Methods The computerised surgical database at The Prince Charles Hospital was reviewed for female survivors of the Rastelli operation who were over 18 years of age in 2004. Their pregnancy and reproductive history was already known or obtained when they were seen in the outpatient clinics. As this review conforms with the standards established by the NHMRC for ethical quality review, 14 Ethics Committee approval was not sought. Results Cardiac and general features There were 22 women over the age of 18 years who had had their Rastelli conduit repair operation between 1977 and 1999. Their ages ranged from 18 to 43 years with a mean of 26.3 years. The age at conduit repair varied from 3 months (for repair of truncus) to 31 years (for repair of complex pulmonary atresia). The mean age at repair was 9 years. Correspondence: Dr Dorothy Radford, The Prince Charles Hospital, Cardiology Department, Rode Road, Chermside, Queensland 4032, Australia. Email: dorothy_radford@health.qld.gov.au Received 24 June 2004; accepted 30 December 2004.