[Heart disease and pregnancy]

Abstract

Pregnancy is associated with important haemodynamic changes that increase during delivery and may decompensate an underlying heart disease. Some situations (fortunately rare) are at very high risk and can contra-indicate pregnancy (Eisenmenger syndrome, severe stenotic left heart valve, severely dilated aorta and severe left ventricular dysfunction). Women with less severe disease can have a pregnancy with specific follow-up (shunt lesions, operated tetralogy of Fallot, mecanical valve). Peri-partum cardiomyopathy is an entity specific to pregnancy because of timing of its diagnosis. The presence of heart disease during pregnancy raises a number of different problems. This underlines the need for a multidisciplinary approach at each phase: before and during pregnancy as well as during the post-partum period. Modalities of delivery should be discussed and planned taking into account the type of heart disease and its tolerance towards the end of pregnancy.