COMMENTARY

Pregnancy in Women With Congenital Heart Disease

Naveen L. Pereira, MD; Carole A. Warnes, MD

Disclosures

February 03, 2014

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Pregnancy in Women With Congenital Heart Disease

Naveen L. Pereira, MD: I am Naveen Pereira, Assistant Professor of Medicine at the Mayo Clinic in Rochester, Minnesota. Today on Mayo Clinic Talks, I will be discussing pregnancy and heart disease with my colleague Carole Warnes, who specializes in adult congenital heart disease and has a specific research and clinical interest in heart disease and pregnancy.

Dr. Warnes was the lead author of the American College of Cardiology and American Heart Association 2008 guidelines for the management of adults with congenital heart disease[1] and is an integral part of the Adult Congenital Heart Disease Program at Mayo Clinic Rochester. Welcome, Carole.

Carole A. Warnes, MD: Thank you.

Dr. Pereira: I look at heart disease and pregnancy as presenting 2 potential scenarios. One is women with preexisting heart disease who then present in pregnancy, and the other is women who are diagnosed with cardiac disease during pregnancy. Within the framework of these scenarios, what are the common cardiac diseases that a cardiologist is likely to encounter? What should the general cardiologist focus on with respect to these types of issues?

Dr. Warnes: Adult congenital heart disease accounts for 1 million of the population in North America. Most maternal cardiovascular disease today is actually congenital in origin. Bicuspid aortic valve stenosis not uncommonly arises in pregnancy. We see rheumatic heart disease occasionally. The other cardiac condition that physicians might encounter in pregnant women is cardiomyopathy, either ischemic or dilated, and even hypertrophic cardiomyopathy.

Congenital heart disease, however, is far and away the most common problem, and that is why I developed an interest in pregnancy. It's a challenge for the cardiologist because symptoms and signs in normal pregnancy can mimic cardiac disease. It is easy to be fooled.

Pregnancy can exacerbate any preexisting cardiac disease. Ideally, we would prefer for woman to have a detailed evaluation before embarking on pregnancy to avoid surprises. Occasionally, particularly because of the volume load of pregnancy, cardiac disease can manifest for the first time during a pregnancy.

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