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Page 6 of 17 Saxena et al. Vessel Plus 2022;6:15 https://dx.doi.org/10.20517/2574-1209.2021.96

Table 1. Modified World Health Organization classification of maternal cardiovascular risk [1]

A
mWHO Class Diagnosis (if otherwise well and uncomplicated)

mWHO I Small or mild pulmonary stenosis, patent ductus arteriosus, mitral valve prolapse
Successfully repaired simple lesions (atrial or ventricular septal defect, patent ductus arteriosus, anomalous pulmonary venous drainage)
Atrial or ventricular ectopic beats, isolated
mWHO II Unoperated atrial or ventricular septal defect
Repaired Tetralogy of Fallot
Most arrhythmias (supraventricular arrhythmias)
Turner syndrome without aortic dilatation
mWHO II-III Mild left ventricular impairment (EF > 45%)
Hypertrophic cardiomyopathy
Native or tissue valve disease not considered WHO I or IV (mild mitral stenosis, moderate aortic stenosis)
Marfan without aortic dilatation
Aorta < 45 mm in bicuspid aortic valve pathology
Repaired coarctation
Atrioventricular septal defect
mWHO III Moderate left ventricular impairment (EF = 30%-45%)
Previous peripartum cardiomyopathy without any residual left ventricular impairment
Mechanical valve
Systemic right ventricle with good or mildly decreased ventricular function
Fontan circulation (if the patient is otherwise well and the cardiac condition uncomplicated)
Unrepaired cyanotic heart disease
Other complex heart disease
Moderate mitral stenosis
Severe asymptomatic aortic stenosis
2
Moderate aortic dilatation (40-45 mm in Marfan syndrome, 45-50 mm in bicuspid aortic valve, Turner syndrome ASI 20-25 mm/m , Tetralogy of Fallot < 50 mm)
Ventricular Tachycardia
mWHO IV Pulmonary arterial hypertension
Severe systemic ventricular dysfunction (EF < 30% or NYHA Class III-IV)
Previous peripartum cardiomyopathy with any residual left ventricular impairment
Severe mitral stenosis
Severe symptomatic aortic stenosis
Systemic right ventricle with moderate or severely decreased ventricular function
2
Severe aortic dilatation (> 45 mm in Marfan syndrome, > 50 mm in bicuspid aortic valve, Turner syndrome ASI > 25 mm/m , Tetralogy of Fallot > 50 mm)
Vascular Ehlers-Danlos
Severe (re)coarctation
Fontan with any complication
B
WHO Class mWHO I mWHO II mWHO II-III mWHO III mWHO IV

Risk No detectable increased risk of Small increased risk of maternal Intermediate increased risk of maternal Significantly increased risk of Extremely high risk of maternal
maternal mortality and no/mild mortality or moderate increase mortality or moderate to severe increase maternal mortality or severe mortality or severe morbidity
increased risk in morbidity in morbidity in morbidity morbidity
Maternal cardiac 2.5%-5% 5.7%-10.5% 10%-19% 19%-27% 40%-100%