Analysis of clinical observations of pregnancy and delivery of patients undergoing corrective surgery for bland—white—garland syndrome

Abstract

Bland—White—Garland syndrome is quite rare in the practice of an internist and is characterized by a congenital pathology of the coronary vessels, consisting in the origin of left coronary artery from pulmonary artery. The consequence of the anomaly is the blood supply of the part of the heart muscle with venous blood, which, starting from infancy, leads to the development of myo-cardial infarction or death. In the article, presented an analysis of the gestation course and approaches to delivery in this patients based on a description of three clinical observations of pregnant women who underwent reconstructive operations on the coronary arteries with regard to the Bland—White—Garland syndrome different by their nature and the long-term results. It was revealed that radical surgery and the preservation of coronary blood flow (even in the presence of concomitant heart disease) ensure the absence of cardiac and obstetric complications. At the same time, the observational data indicate that the absence of visualization of the left coronary artery during computed tomography of the heart, which was a consequence of its ligation or possible throm-bosis of the coronary artery bypass graft, may be accompanied by the appearance of severe life-threatening rhythm disturbances in pregnant women with impaired fetoplacental blood flow. The authors noted a satisfactory effect of antiarrhythmic therapy in these cases, and computed tomography of the heart with vascular contrast and 24-hour Holter monitoring must be included in the pre-conception preparation of patients who underwent corrective surgery for Bland—White—Garland syndrome.