Congenital Heart Disease
Several recent studies have addressed congenital heart disease (CHD) in pregnancy. In general, regurgitant lesions are well tolerated, whereas obstructive lesions are poorly tolerated. One well-cited retrospective study4 found no maternal deaths during analysis of 90 pregnancies in mothers who had CHD. However, 17% had pulmonary edema and 12% had cardiac events (most frequently a nonsustained tachyarrhythmia). A recent meta-analysis of 2,491 pregnancies in patients with CHD5 showed a miscarriage rate of 15% and a lower cardiovascular event rate of 6%. This study also found an 8% incidence of congenital heart disease in the offspring, which is similar to the findings of other studies.
The Cardiac Disease in Pregnancy (CARPREG) Risk Score (Table I) can be calculated to estimate a woman's cardiac risk during pregnancy.6 One point is assigned for each of the following risk factors: a history of cardiac event or arrhythmia, New York Heart Association functional class greater than II or cyanosis, left-heart obstruction (mitral valve area