ACC-2017 Pregnancy - CHD
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. | ||