ACC-2017 Pregnancy - CHD

Template:NOAC Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]

Management of Pregnancy in Patients With Complex Congenital heart Disease

Modified Who Classification of Maternal Cardiovascular Risk

Who Pregnancy risk Category	Risk Description	Maternal risk factors
I	No detectable increase in maternal mortality and no/mild increase in morbidity risk	Uncomplicated small/mild pulmonary stenosis, PDA, mitral valve prolapse; Successfully repaired simple lesions (ASD, VSD, PDA, anomalous pulmonary venous drainage); Atrial or ventricular ectopic beats, isolated
II	Small increase in maternal mortality and moderate increase in morbidity risk	If otherwise well and uncomplicated: Unoperated ASD, VSD; Repaired TOF; Most arrhythmias
II–III	Moderate increase in maternal mortality morbidity risk	Mild LV impairment; Hypertrophic cardiomyopathy; Native or tissue valvular disease (not considered risk category I or IV); Marfan syndrome without aortic dilation; Aortic dilation <45 mm in bicuspid aortic valve aortopathy; Repaired coarctation
IV	Extremely high maternal mortality or severe morbidity risk. Pregnancy is contraindicated. In the event of pregnancy, termination should be discussed. If pregnancy continues, care should follow class III recommendations.	Pulmonary arterial hypertension (of any cause); Severe systemic ventricular dysfunction (LV ejection fraction <30%, NYHA class III-IV); Previous peripartum cardiomyopathy with any residual impairment of LV function; Severe mitral stenosis, severe symptomatic aortic stenosis; Aortic dilation >45 mm in Marfan syndrome; Aortic dilation >50 mm in bicuspid aortic valve aortopathy; Native severe coarctation
AS indicates aortic stenosis; ASD, atrial septal defect; CHD, congenital heart disease; LV, left ventricular; NYHA, New York Heart Association; PDA, patent ductus arteriosus; RV, right ventricle; TOF, tetralogy of Fallot; VSD, ventricular septal defect; and WHO, World Health Organisation.