T he prevalence of pregnancies complicated by
rheumatic heart disease has decreased in North
America and Western Europe in the last two
decades, but pregnancies in patients with congenital
heart disease, often with complex anomalies, are occurring
more frequently. This is due to the increased
number of women with congenital heart anomalies now
surviving to adulthood because of successful cardiac
surgery and improved care during infancy and childhood.
Previous studies of series and case reports1-3
suggest that cyanotic congenital heart disease adds a
greater risk to pregnancy than other lesions, but information
from more patients is required to make useful
recommendations.There are a number of conditions deemed unsuitable
for radical repair because of the basic anatomy but
nevertheless are compatible with survival. Such lesions
as complex pulmonary atresia with aortopulmonary
collaterals, defects complicated by the Eisenmenger
reaction, and single-ventricle hearts (with and without
earlier palliation) are in this category. Some cyanotic
patients reach adulthood without serious symptoms
necessitating surgery, such as those with mild tetralogy
of Fallot, Ebstein's anomaly, and some cases of corrected
transposition with pulmonary stenosis and ventricular
septal defect.