ACC-2017 Pregnancy - CHD: Difference between revisions
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| I || No detectable increase in maternal mortality and no/mild increase in morbidity risk || Uncomplicated small/mild pulmonary stenosis, PDA, mitral valve prolapse; | | I || No detectable increase in maternal mortality and no/mild increase in morbidity risk || Uncomplicated small/mild pulmonary stenosis, PDA, mitral valve prolapse; | ||
Successfully repaired simple lesions (ASD, VSD, PDA, anomalous pulmonary venous drainage); | Successfully repaired simple lesions (ASD, VSD, PDA, anomalous pulmonary venous drainage); Atrial or ventricular ectopic beats, isolated | ||
Atrial or ventricular ectopic beats, isolated | |||
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| II || Small increase in maternal mortality and moderate increase in morbidity risk || If otherwise well and uncomplicated: Unoperated ASD, VSD; | | II || Small increase in maternal mortality and moderate increase in morbidity risk || If otherwise well and uncomplicated: Unoperated ASD, VSD; | ||
Repaired TOF; Most arrhythmias | Repaired TOF; | ||
Most arrhythmias | |||
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| II–III || Moderate increase in maternal mortality morbidity risk || Mild LV impairment; | | II–III || Moderate increase in maternal mortality morbidity risk || Mild LV impairment; | ||
Hypertrophic cardiomyopathy; | Hypertrophic cardiomyopathy; | ||
Native or tissue valvular disease (not considered risk category I or IV); Marfan syndrome without aortic dilation; | |||
Native or tissue valvular disease (not considered risk category I or IV); | |||
Marfan syndrome without aortic dilation; | |||
Aortic dilation <45 mm in bicuspid aortic valve aortopathy; | Aortic dilation <45 mm in bicuspid aortic valve aortopathy; | ||
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Severe systemic ventricular dysfunction (LV ejection fraction <30%, NYHA class III-IV); | Severe systemic ventricular dysfunction (LV ejection fraction <30%, NYHA class III-IV); | ||
Previous peripartum cardiomyopathy with any residual impairment of LV function; Severe mitral stenosis, severe symptomatic aortic stenosis; Aortic dilation >45 mm in Marfan syndrome; | Previous peripartum cardiomyopathy with any residual impairment of LV function; | ||
Severe mitral stenosis, severe symptomatic aortic stenosis; | |||
Aortic dilation >45 mm in Marfan syndrome; | |||
Aortic dilation >50 mm in bicuspid aortic valve aortopathy; | Aortic dilation >50 mm in bicuspid aortic valve aortopathy; | ||
Revision as of 16:35, 2 November 2017
Template:Pregnancy -CHD - 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]
Management of Pregnancy in Patients With Complex Congenital heart Disease
Modified Who Classification of Maternal Cardiovascular Risk
| Who Pregnancy Risk Category | Risk Description | Maternal Risk Factors |
|---|---|---|
| I | No detectable increase in maternal mortality and no/mild increase in morbidity risk | Uncomplicated small/mild pulmonary stenosis, PDA, mitral valve prolapse;
Successfully repaired simple lesions (ASD, VSD, PDA, anomalous pulmonary venous drainage); Atrial or ventricular ectopic beats, isolated |
| II | Small increase in maternal mortality and moderate increase in morbidity risk | If otherwise well and uncomplicated: Unoperated ASD, VSD;
Repaired TOF; Most arrhythmias |
| II–III | Moderate increase in maternal mortality morbidity risk | Mild LV impairment;
Hypertrophic cardiomyopathy; Native or tissue valvular disease (not considered risk category I or IV); Marfan syndrome without aortic dilation; Aortic dilation <45 mm in bicuspid aortic valve aortopathy; Repaired coarctation |
| IV | Extremely high maternal mortality or severe morbidity risk. Pregnancy is contraindicated. In the event of pregnancy, termination should be discussed. If pregnancy continues, care should follow class III recommendations. | Pulmonary arterial hypertension (of any cause);
Severe systemic ventricular dysfunction (LV ejection fraction <30%, NYHA class III-IV); Previous peripartum cardiomyopathy with any residual impairment of LV function; Severe mitral stenosis, severe symptomatic aortic stenosis; Aortic dilation >45 mm in Marfan syndrome; Aortic dilation >50 mm in bicuspid aortic valve aortopathy; Native severe coarctation |
| AS indicates aortic stenosis; ASD, atrial septal defect; CHD, congenital heart disease; LV, left ventricular; NYHA, New York Heart Association; PDA, patent ductus arteriosus; RV, right ventricle; TOF, tetralogy of Fallot; VSD, ventricular septal defect; and WHO, World Health Organisation. | ||