Heart Disease in pregnancy

Mortality risk associated with pregnancy

Group I – Mortality <1%

1. Shunts: ASD, VSD, PDA, Corrected TOF
2. Valve replacement: Biosynthetic
3. Right sided valvular disease: Pulmonary or tricuspid
4. Mitral stenosis: NYHA I and II

Group II – Mortality 5-15%

• Left sided valvular disease: Coarctation of aorta, Aortic stenosis
• Mitral stenosis: with AF or NYHA III and IV
• Valve replacement: Mechanical
• Others: Uncorrected TOF, Previous MI

Group III – Mortality 25-50%

• Pulmonary hypertension (primary or secondary i.e. Eisenmenger’s syndrome)
• Complicated coarctation of aorta
• Marfan syndrome with aortic root involvement (>40 mm)

Commonest in Pregnancy

Valvular heart disease: Mitral stenosis

Congenital heart disease: ASD

Cyanotic congenital heart disease: Fallot’s tetralogy (TOF)

Predictors of Cardiac Events during Pregnancy

N – NYHA Class >II

O – Obstructive lesions of left heart (Aortic valve <1.5 cm; Mitral valve <2 cm)

P – Pre-pregnancy cardiac events (Heart failure, arrhythmia, TIA, Stroke)

E – Ejection fraction <40%

Number of predictors equals risk of cardiac events:

• 0: 5%
• 1: 27%
• >1: 75%