Mortality risk associated with pregnancy
Group I – Mortality <1%
- Shunts: ASD, VSD, PDA, Corrected TOF
- Valve replacement: Biosynthetic
- Right sided valvular disease: Pulmonary or tricuspid
- 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%