[Pregnancy and congenital heart disease]

Abstract

Congenital cardiopathies currently represent the majority of cardiac anomalies observed during pregnancy. The latter leads to significant haemodynamic modifications which can sometimes be poorly tolerated in the case of severe cardiopathy. However, as a rule pregnancy is generally well supported if the functional state of the patient beforehand is satisfactory (class I or II of the NYHA). The type of cardiopathy also plays a role. Left-right shunts tolerate pregnancy well in most cases. On the other hand severe aortic stenoses expose serious complications. Above all it is the cyanogenic cardiopathies which are poorly tolerated by the mother and the fetus, and more so the lower the oxygen saturation. Eisenmenger's syndrome causes a major risk to life for the young mother and is a formal contra-indication to pregnancy, as is pulmonary arterial hypertension. Patients with a Fontan anastomosis or an intra-atrial repair of transposition of the great vessels can support pregnancy very well if the systemic ventricle has good function. In Marfan's syndrome the aortic diameter is the essential prognostic element. In most congenital cardiopathies pregnancy nevertheless has a favourable outcome for the mother and infant. Vaginal delivery should be the rule. A close cardio-obstetric collaboration is the principal condition to allow the young cardiac female to well endure a pregnancy.