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Page 14 of 17 Saxena et al. Vessel Plus 2022;6:15 https://dx.doi.org/10.20517/2574-1209.2021.96

Other congenital heart diseases
Pregnancy is well tolerated in most patients with an atrial septal defect (ASD) or a patent ductus arteriosus
(PDA) as long as there is no PH. Thromboembolic complications and arrhythmias are slightly more
common in patients with unrepaired ASD as compared to healthy women. The maternal and fetal outcomes
are good, and no specific treatment is required. Prognosis is also good in women with corrected shunt
lesions (ASD/ventricular septal defect/PDA) with no residual abnormalities.

Atrioventricular septal defects (ostium primum ASD) are best repaired before conception as arrhythmias
[53]
and worsening of atrio-ventricular valve regurgitation are well described during pregnancy .

Mild to moderate pulmonary stenosis are well tolerated during pregnancy with good fetal and neonatal
outcome. Severe pulmonary stenosis can result in right ventricular failure and arrhythmias and, in cases
with severe symptoms, may necessitate percutaneous balloon dilatation.

Ebstein’s anomaly without cyanosis and heart failure is tolerated well during pregnancy. The incidence of
[54]
arrhythmias is higher during pregnancy and may worsen the outcome . Women with right-to-left
shunting through the defect in interatrial septum (patent foramen ovale/ASD present in 90% of cases) can
develop progressive cyanosis during pregnancy and are at increased risk of paradoxical embolism. Women
with Ebstein’s anomaly having symptoms, cyanosis, or heart failure are best treated surgically before
conception.

In women with congenitally corrected transposition of great arteries, the risk depends on functional status,
systemic right ventricle function, and associated tricuspid regurgitation. They are at increased risk of
developing arrhythmias and heart failure (WHO risk Class III). Women with NYHA Classes III or IV,
[1]
severe ventricular dysfunction, or severe tricuspid regurgitation should be counseled against pregnancy .

CONCLUSION
CHD is the most common heart disease in pregnant patients in developed countries, and this cohort is
gradually increasing even in developing countries. The risk of complications during pregnancy in women
with CHD largely depends on the type of underlying CHD and pre-pregnancy cardiac state. This
emphasizes the importance of risk assessment and counseling prior to pregnancy. High-risk patients are
best treated by a multidisciplinary team in a specialized center. Lesion-specific considerations and risk
stratification should determine management decisions during pregnancy, labor, delivery, and the postnatal
period in these patients. Women with severe pulmonary hypertension, Eisenmenger syndrome, severe left
ventricular dysfunction, bicuspid aortic valve with aortic dilatation > 50 mm, and severe symptomatic left
ventricular outflow tract obstruction should be offered termination of pregnancy if detected in time.
Improvement in existing practices of assessment and management of women with CHD will result in
substantial improvement in outcomes for the mother and fetus.

DECLARATIONS
Authors’ contributions
Did literature review and composed the first draft of the article: Saxena A
Reviewed data and worked on the subsequent revisions: Relan J
Conceptualized the study design, reviewed progress of the article at each step, and finalized the manuscript
of the review article: Saxena A