Congenital Heart Disease and Pregnancy. What Do We Know in 2008?

Abstract

Cardiac disease is the leading medical cause of material death during pregnancy in the United Kingdom. 1 Due to recent advances in cardiac surgery and congenital heart disease, the butter is now the most common subtrate of heart disease in pregnancy in the western world. 2 The combination of cardiac disease and pregnancy carry mortality and morbidity risks such as heart failure, thromboembolism, and cardiac arrhythmia. Furthermore, fetal and neonatal adverse events, including intrauterine growth restriction, premature birth, intracranial haemorrhage, and fetal loss are relatively common. Prepregnancy counselling (Table), including advice on contraception, and optimal care during pregnancy is, thus, becoming a major topic in current cardiologic and obstetric practice. The first task is to asses the risks of pregnancy for the mother. Pregnancy is associated with profound changes in peripheral resistance, cardiac output, and blood volume, in order to provide appropriate uterine blood flow. In the first trimester of pregnancy, the blood pressure falls secondary to a drop in peripheral vascular resistance. Thereafter, plasma volume increases by 25%, and this change in volume is associated with an accelerated heart rate and a 50% increase in cardiac output. Blood pressure starts to rise in the beginning of the third trimester. Structural changes to the heart and great vessels also occur and include myocardial hypertrophy, chamber enlargement, and valvular regurgitation. 3-11 These major cardiovascular changes may, in women with cardiac disease, be poorly tolerated and precipitate heart failure and clinical decompensation. Proarrhythmic effects and