gynecology and obstetrics
Heart Disease in Pregnancy
Introduction
Cardiovascular conditions, including cardiomyopathy, are responsible for approximately 26% of all pregnancy-related deaths. In the United States, because incidence of rheumatic heart disease has markedly declined, most heart problems during pregnancy result from congenital heart disease. However, in Southeast Asia, Africa, India, the Middle East, and parts of Australia and New Zealand, rheumatic heart disease is still common. Despite dramatic improvements in survival and quality of life for patients with severe congenital heart defects and other heart disorders, pregnancy remains inadvisable for women with certain high-risk conditions such as the following ( General reference ): Pulmonary Hypertension (pulmonary artery systolic pressure > 25 mm Hg) caused by any condition, including Eisenmenger syndrome Coarctation of the Aorta if uncorrected or if accompanied by an aneurysm Marfan Syndrome with aortic root diameter of > 4.5 cm Severe symptomatic Aortic Stenosis or severe Bicuspid aortic valve with ascending aorta diameter > 50 mm A single ventricle and impaired systolic function (whether treated with the Fontan procedure or not) Overview of Cardiomyopathies with ejection fraction < 30% or New York Heart Association (NYHA) class III or IV heart failure (see table 