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| {{Pregnancy and heart disease}}
| | #REDIRECT [[Cardiac disease in pregnancy and congenital heart disease]] |
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| {{CMG}}; '''Associate Editor-In-Chief:''' {{AC}}
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| ==Overview==
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| The most common maternal cardiac disease in Western societies is now congenital heart disease. This includes a wide spectrum of abnormalities, which are delineated in this section. This is largely due in part to the fact that children born with congenital heart defects in Western societies are living to the ages at which they can bear children. This section will not detail those patients that have repaired congenital defects, which are highlighted in the [[Pregnancy and heart disease repaired congenital heart disease|Repaired Congenital Heart Disease]] section.<ref name="pmid7113941">{{cite journal| author=Whittemore R, Hobbins JC, Engle MA| title=Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. | journal=Am J Cardiol | year= 1982 | volume= 50 | issue= 3 | pages= 641-51 | pmid=7113941 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7113941 }} </ref>
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| ==[[Atrial septal defect and pregnancy|Atrial Septal Defects]]==
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| Pregnancy causes an increase in [[cardiac output]] and [[stroke volume]]. This can cause an increased [[left-to-right shunt]]ing of blood. Despite the increased workload on [[heart]], females with isolated asymptomatic [[atrial septal defect]]s tolerate the pregnancy well. Pregnant females with an atrial septal defect may have increased frequencies of some complications for instance [[arrhythmias]], [[thromboembolism]], and [[bleeding]]. Despite this, there are no studies suggesting that there are different indications for ASD closure in pregnant females with atrial septal defect when compared to a non-pregnant female with [[atrial septal defect]]. The ACC/[[AHA]] guidelines, however, do dictate clear deviations in course of treatment in certain special circumstances. According to ACC/AHA guidelines pregnancy could be harmful in females with [[atrial septal defect]] and severe [[pulmonary hypertension]] ([[Eisenmenger syndrome]])
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| ==[[Ventricular septal defect|Ventricular Septal Defects]]==
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| Congential [[ventricular septal defects]] [[VSD]]s are collectively the most common [[congenital heart defect]]. The incidence of [[VSD]] in adulthood has decreased over past decades due to successful surgical closure of large defects.<ref>Allwork SP, Anderson RH. Developmental anatomy of the membranous part of the ventricular septum in the human heart. Br Heart J 1979; 41:275-280</ref> Pregnancy in patients with [[VSD]] and severe [[pulmonary arterial hypertension]] ([[PAH]]) ([[Eisenmenger syndrome]]) is not recommended owing to excessive maternal and fetal mortality and should be strongly discouraged. See [[ventricular septal defect ACC/AHA guidelines |ACC/AHA guidelines]] for details.
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| ==[[Patent ductus arteriosus|Patent Ductus Arteriosus]]==
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| Generally small defects do not cause significant hemodynamic issues during pregnancy. The exception, as in other cases, is with those with [[pulmonary hypertension]]. [[PDA]]s with a very large shunt may also lead to [[ventricular failure]] in the setting of the hemodynamic changes of pregnancy.
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| ==[[Aortic coarctation|Aortic Coarctation]]==
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| Aortic coarctation occurs in approximately 6-10% of all [[congenital heart disease]] cases. It often presents in pregnancy due to systemic [[hypertension]]. This can lead to small-for-dates babies and fetal loss. Most women have a successful pregnancy with [[coarctation]] but may require imaging of the aorta during prenatal care. [[Aortic coarctation treatment|Treatment options]] include medical, surgical, and catheter-based therapies.
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| ==[[Pulmonary valve stenosis|Pulmonary Stenosis]]==
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| Generally congenital [[pulmonary stenosis]] is well tolerated if it is mild or repaired by surgery or [[valvuloplasty]]. It should be noted that although a woman with severe [[pulmonic stenosis]] may be asymptomatic prior to pregnancy, the hemodynamics of pregnancy can lead to [[right heart failure]] or [[atrial arrhythmias]]. Balloon [[valvuloplasty]] is feasible even during pregnancy in the setting of symptoms.<ref name="pmid11359761">{{cite journal| author=Siu SC, Colman JM| title=Heart disease and pregnancy. | journal=Heart | year= 2001 | volume= 85 | issue= 6 | pages= 710-5 | pmid=11359761 | doi= | pmc=PMC1729784 | url= }} </ref>
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| ==Congenital Aortic Stenosis==
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| Generally aortic stenosis in women of childbearing age will be secondary to a [[Bicuspid aortic stenosis|bicuspid aortic valve]]. Whether or not pregnancy is contraindicated depends on the severity of aortic stenosis. An [[Aortic stenosis echocardiography or ultrasound|echocardiogram]] should be performed to determine severity; mild aortic stenosis is usually well tolerated in pregnancy, however moderate and severe may not be. Moderate stenosis may be tolerated in a compliant patient who is monitored closely. In addition, aortic root dilation > 4.5cm is a contraindication to pregnancy.
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| Balloon valvuloplasty has been safely performed in a small subset of pregnancy patients with some success, as described by Myerson et al.<ref name="pmid15792172">{{cite journal| author=Myerson SG, Mitchell AR, Ormerod OJ, Banning AP| title=What is the role of balloon dilatation for severe aortic stenosis during pregnancy? | journal=J Heart Valve Dis | year= 2005 | volume= 14 | issue= 2 | pages= 147-50 | pmid=15792172 | doi= | pmc= | url= }} </ref>
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| ==[[Ebstein's anomaly of the tricuspid valve|Ebstein Anomaly]]==
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| '''Ebstein's anomaly''' is a congenital heart defect in which the opening of the [[tricuspid valve]] is displaced towards the apex of the [[right ventricle]] of the heart (congenital apical displacement of the [[tricuspid valve]] that typically causes significant [[tricuspid regurgitation]]).
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| The presence of atrial communication and maternal cyanosis greatly increases the risk of pregnancy. In addition, increased right ventricular size, a high degree of tricuspid regurgitation, and atrial arrhythmias all contribute to increased risk during pregnancy. Therefore, safety in pregnancy is quite variable and patients should be followed very closely.
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| ==References==
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| {{Reflist|2}}
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| [[Category:Cardiology]]
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| [[Category:Obstetrics]]
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| [[Category:Disease]]
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| {{WH}}
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| {{WS}}
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