Study of Pregnancy Outcome in Maternal Heart DiseasHeart disease is the leading cause of maternal mortality in the UK. Cardiomyopathy,
myocardial infarction and aneurysm or dissection of the aorta
are the leading causes of death from acquired heart disease while pulmonary
hypertension is the leading cause of death from congenital heart
disease. Congenital heart disease is the predominant form of heart disease
encountered in pregnancy as most women with congenital heart disease
now survive to adulthood due to the successes of paediatric cardiology and
cardiac surgery. Patients with heart disease should receive multi-disciplinary
counselling and risk assessment to enable an informed decision regarding
pregnancy. Appropriate contraceptive advice should also be given. Physiological
changes in pregnancy should be understood as they may precipitate
decompensation in patients with previously well tolerated lesions. This
article briefly reviews congenital and acquired cardiac lesions that are important
because they are common conditions or because pregnancy poses
a particular risk. Early involvement of a cardiologist is recommended in any
pregnant woman with chest pain and ECG changes. Ischaemic heart disease
and cardiomyopathy (dilated, peripartum, hypertrophic) are discussed.
The management of pregnant women with prosthetic heart valves can be
complex and choice of anti-coagulant needs to be individualised with close
monitoring by a specialist team. Pregnancy is in-advisable in pulmonary
hypertension, severe un-operated left sided stenosis, severely impaired
ventricular function and Marfan syndrome with a dilated aortic root.