Cardiac disease in pregnancy contraindications to pregnancy

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Special Scenarios: I. Pre-existing Cardiac Disease: Congenital Heart Disease Repaired Congenital Heart Disease Pulmonary Hypertension Rheumatic Heart Disease Connective Tissue Disorders II. Valvular Heart Disease: Mitral Stenosis Mitral Regurgitation Aortic Insufficiency Aortic Stenosis Mechanical Prosthetic Valves Tissue Prosthetic Valves III. Cardiomyopathy: Dilated Cardiomyopathy Hypertrophic Cardiomyopathy Peripartum Cardiomyopathy IV. Cardiac diseases that may develop During Pregnancy: Arrhythmias Acute Myocardial Infarction Hypertension
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Absolute and relative contraindications to pregnancy include severe pulmonary arterial hypertension; severe fixed valve stenoses (AS,MS,PS,HOCM, coarctation; Class III or IV congestive heart failure with a left ventricular ejection fraction of < 40%; a history of peripartum cardiomyopathy; a dilated aorta such as in Marfan's syndrome with an aortic arch >40-45 mm; and severe cyanosis.

Contraindications to Pregnancy

Conditions in Which Pregnancy is NOT ADVISED

• Severe pulmonary arterial hypertension which is associated with a 30% to 50% risk of maternal mortality.
• Severe fixed obstructive lesions such as aortic stenosis, mitral stenosis, pulmonic stenosis, hypertrophic obstructive cardiomyopathy, coarctation of the aorta
• Left ventricular systolic dysfunction

• Class III or IV CHF, EF <40%
• Prior peripartum cardiomyopathy

• Dilated or unstable aorta

• Marfan's syndrome

• Aorta >45 mm: strongly discourage pregnancy
• Aorta is <40 mm: the risk is not as high, but there is no safe aortic diamter.
• Aorta 40-45 mm: Evaluate the rate of aortic growth and family history. Even after repair, Marfan's syndrome patients remain at risk of dissection in the residual aorta.

• Severe cyanosis