Pregnancy and heart disease congenital heart disease

Cardiac disease in pregnancy Microchapters
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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]; Associate Editor-In-Chief: Anjan K. Chakrabarti, M.D. [2] Priyamvada Singh, M.B.B.S. [3]; Cafer Zorkun, M.D., Ph.D. [4] Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]

Overview

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 Repaired Congenital Heart Disease section.

Atrial Septal Defects

Pregnancy causes an increase in cardiac output and stroke volume. This can cause an increased left-to-right shunting of blood. Despite the increased workload on heart, females with isolated asymptomatic atrial septal defects 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 pregnancy requires different indications for closure in pregnant females with atrial septal defect 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)

Ventricular Septal Defects

Congential VSDs 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.

Pregnancy in patients with VSD and severe PAH (Eisenmenger syndrome) is not recommended owing to excessive maternal and fetal mortality and should be strongly discouraged. See ACC/AHA guidelines for details.

Patent Ductus Arteriosus

Generally small defects do not cause significant hemodynamic issues during pregnancy. The exception, as in other cases, is with those with pulmonary hypertension. PDAs with a very large shunt may also lead to ventricular failure in the setting of the hemodynamic changes of pregnancy.

References

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