Prospective evaluation from single centre of pregnancy in women with congenital heart disease

Objectives: Study of outcomes of pregnancy in women with congenital heart disease. Material and methods: The cardiac state during and after pregnancy was analysed in 173 women (mean age 28 years, range 21-41) referred for fetal echocardiography and evaluation of maternal heart during 201 pregnancies. Acyanotic lesions were present in 152 women (100 operated), in 175 pregnancies; cyanotic lesions in 21, all operated, in 26 pregnancies. Eighteen patients in 20 pregnancies (9.9% pregnancies) presented an increased risk due to severe arrhythmias or relevant residual hemodynamic lesions (risk group). Results: Complications related to heart defects occurred in 9/201 (4.5%), pregnancies: in 6/175 (3.4%) pregnancies with acyanotic lesions, in 3/26 (11.5%) with cyanotic lesions and in 9/20 pregnancies of the risk group (45%), with a statistically significant difference with respect to the non-risk group. Two cases had serious tachyarrhythmias, five worsened hemodynamic state or cyanosis, one had hemorrhage post-partum on anticoagulants and one died of a rupture of isthmic aneurysm post-coarctectomy. Prematurity occurred in 19.2% of pregnancies with cyanotic and 5.7% with acyanotic lesions. There were 6/201 recurrences of cardiac anomaly (3%). Conclusions: Patients with uncomplicated heart disease had normal course of pregnancy, while complications due to serious arrhythmias or residual hemodynamical lesions and cyanosis occurred in 4.5% of pregnancies and, mainly in 45% of those with increased risk. Thorough evaluation of the cardiologic risk is mandatory for a correct counseling of women planning pregnancy.