High Cardiac Risk Pregnancy States
Contraindications to pregnancy generally consist of 4 states7: Marfan syndrome with dilated aortic root (>4 cm), pulmonary hypertension (pulmonary vascular resistance, >6 Wood units), moderate-to-severe left ventricular outflow tract obstruction (≥30 mmHg), and LVEF < 0.30 (Table II). If a woman with one of these conditions becomes pregnant, early consultation with a maternal-fetal medicine specialist and a cardiologist should be done in order to evaluate the patient's risk and develop the plan of care. Pregnancy with pulmonary hypertension (Fig. 1) confers a prohibitively high cardiac risk and carries a combined maternal and fetal mortality rate that approaches 50%. Termination of pregnancy should be considered in this condition.7
Fig. 1 Transthoracic echocardiogram (apical 4-chamber view) shows complete atrioventricular canal defect with secondary pulmonary hypertension. Note the large atrioventricular septal defect (AVSD), right ventricular hypertrophy (RVH), and right atrial