Pregnancy in Women With Congenital Heart Disease

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


February 03, 2014

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Cardiac Contraindications to Pregnancy

Dr. Pereira: Are there certain patients with congenital heart disease patients whom you would advise not to consider pregnancy?

Dr. Warnes: Absolutely. Number one on the list are women with pulmonary hypertension, and particularly those with Eisenmenger syndrome. Unfortunately, even in the current era with the modern therapies that we can offer patients, maternal mortality in those with a lesion such as Eisenmenger syndrome is still about 30%. That is very serious.

Other conditions in which we are concerned about maternal and fetal survival are those associated with poor ventricular function, when the ejection fraction is less than 30%. In those women, we worry that the ventricle will not tolerate the volume load of pregnancy.

Other worrisome conditions are a dilated aorta (for example, Marfan syndrome), or a bicuspid aortic valve and, of course, the aortopathy that accompanies it. If the aorta is larger than 45 mm, we worry that pregnancy will soften the aorta and pose a risk for dissection and rupture.

If a woman has a symptomatic obstructive lesion, such as aortic stenosis, before she becomes pregnant, that needs to be managed before pregnancy is considered, because it will become worse. We have encountered situations where we even need to perform cardiac surgery or balloon valvotomy during pregnancy.

Last, but not least, is something that is not an absolute contraindication. Prosthetic valves are difficult to manage during pregnancy, and these women must be counseled appropriately. If they choose to proceed with pregnancy, they should be followed in a tertiary care center.

Dr. Pereira: That is an excellent summary of the possible contraindications to pregnancy in women with underlying cardiac disease.


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