This study found that QoL in pregnant women with ASD was improved overall following percutaneous closure of ASD with guidance by transthoracic echocardiography.
ASD was a common congenital heart disease for which percutaneous closure was the first-line procedure. However, patients with ASD who were pregnant comprise a special group. In pregnancy, circulating blood volume could increase, which, when combined with a left-to-right shunt can increase the load of the right ventricle and, in cases of large ASD, could lead to pulmonary hypertension and right ventricular dysfunction. Current guidelines recommended cardiological surveillance for all pregnant women with ASD as they were at risk (albeit a small risk) of paradoxical embolism, arrhythmia, and heart failure [8]. Further, percutaneous closure of ASD was an effective and safe procedure for this issue; however, although the time of X-ray fluoroscopy was very short, lasting only a few minutes, and the abdomen was covered with lead clothing, pregnant women were quite often concerned that X-rays will harm the fetus. Thus, guidance by transthoracic echocardiography had been developed for the safe and effective percutaneous closure of ASD [9, 10] as this procedure did not require X-ray fluoroscopy, eliminating radiation concerns.
In this study, we found that QoL in pregnant women with ASD before procedure was lower than that of healthy pregnant controls (in their second trimester). Additionally, QoL was greatly improved following the procedure and was no different from that of healthy pregnant women (in their third trimester). Pregnant women might experience nervousness and depression due to decreased cardiac function or fear of harm to the fetus, thus having a reduced QoL. In our study, participants with ASD underwent successful procedure without complications (arrhythmias, embolisms, or residual shunts). Post-procedure echocardiographic data also showed improvement of right ventricular function. In a previous study, Eroglu et al. [11] reported that the right ventricle was reconstructed 24 h after the closure of ASD, and that the clinical and hemodynamics of patients were improved and maintained during the long-term follow-up period [12, 13]. Additionally, Lazic et al. [14] had reported that the right side of the heart is associated with aerobic capacity. Therefore, owing to the improvement of heart function and the elimination of worry, the overall QoL of pregnant women was expected to improve following surgical closure of the ASD.
In this study, we found that post-procedure pregnant women in the 31–40 years of age and the second or third pregnancy groups had higher scores those in the 20–30 years of age and the first pregnancy groups in the social function and role emotional dimensions. These findings were consistent with previous reports in the literature. For example, García-Blanco et al. [15] reported that social functioning (family functioning, maternal attitudes, and social support) improved with age. McHorney et al. [16] reported that advanced maternal age women was associated with a six or more point increase in the social functioning or role emotional QoL domains. Further, Berryman et al. [17] showed that older pregnant women possessed a greater sense of preparedness and more flexible problem-solving capacities. Thus, it standed to reason that second or third pregnant women would perform better in these aspects due to their experience in pregnancy, suggesting that younger women and those on their first pregnancy should be provided more psychological intervention and social support.
