Interv Akut Kardiol 2019; 18(3, Suppl.A): 36-41 | DOI: 10.36290/kar.2019.051

Pregnancy in women with congenital heart disease

Jana Rubáčková Popelová

Centrum pro vrozené srdeční vady v dospělosti, Kardiochirurgické odd. Nemocnice Na Homolce, Praha

The risk of pregnancy and giving birth can vary a lot in patients with congenital heart disease (CHD). A low risk is generally found in those in the NYHA I and II functional class, with a maximum oxygen consumption above 25–30 ml/kg/min, with simple CHD after repair with no residual finding, with less significant valvular regurgitations, with well-functioning biological prostheses and native valves after plastic surgery, or with a small shunt defect without pulmonary hypertension. A high risk is found in women in the NYHA III and IV functional class, those with significant stenotic defects, with mechanical valve prostheses, cyanotic CHD with saturation below 90%, those with Fontan circulation or systemic right ventricle, and women with pulmonary hypertension. Pregnancy is contraindicated in Eisenmenger syndrome. There is a risk of aortic dissection or rupture in Marfan syndrome with an aortic size above 40 mm and in Turner syndrome with an aortic size above 20–25 mm/m2 of body surface. Maternal risk according to the modified WHO classes and to the latest guidelines is presented. Also discussed is the risk of using particular drugs and performing procedures in pregnancy as well as the management when anticoagulant therapy is required in pregnancy.

Keywords: pregnancy in women with congenital heart disease, anticoagulant therapy in pregnancy, high-risk pregnancy, drugsin pregnancy, pulmonary hypertension, aortic dilatation

Published: November 1, 2019  Show citation