Table 2.
High-risk congenital heart disease in pregnancy. CHD: congenital heart disease; LV: left ventricle; mWHO: modified World Health Organization; NYHA: New York Heart Association; CARPREG: Cardiac Risk in Pregnancy Study; BAV: bicuspid aortic valve; HCTD: high risk connective tissue disease
|
| ||
|---|---|---|
| CONGENITAL HEART DISEASE | PHYSIOLOGICAL VARIABLE | mWHO RISK (III vs IV) |
|
| ||
| Congenital severe aortic stenosis | Asymptomatic | III |
|
| ||
| Symptomatic | IV | |
|
| ||
| Unrepaired CHD | Hypoxemia (O2 < 94%) | III (degree of hypoxemia not addressed in mWHO or CARPREG 2) |
|
| ||
| Severe hypoxemia | ||
|
| ||
| Systemic right ventricle | Good or mildly reduced RV function | III |
|
| ||
| Moderate to severely reduced RV function | IV | |
|
| ||
| Fontan circulation | Well and uncomplicated | III |
|
| ||
| Arrhythmias | IV | |
|
| ||
| Degree of hypoxemia | IV | |
|
| ||
| Moderate to severe systemic ventricular dysfunction | IV | |
|
| ||
| NYHA functional class | IV | |
|
| ||
| Re-coarctation | Not severe | II-III |
|
| ||
| Severe | IV | |
|
| ||
| Any anatomically simple, moderate, or complex congenital heart disease | Pulmonary hypertension (including Eisenmenger syndrome) | IV |
|
| ||
| Moderate LV dysfunction (EF 30-45%) | III (Unless classified as IV due to NYHA FC III-IV) | |
|
| ||
| Severe LV dysfunction (EF < 30%) | IV | |
|
| ||
| NYHA Functional Class II-IV | IV | |
|
| ||
| Arrhythmia | Not addressed in mWHO, use CARPREG for risk assessment | |
|
| ||
| Mechanical valve | III | |
|
| ||
| Aortopathy | Moderate aortic dilatation (40-45 mm in Marfan syndrome or other HCTD; 45–50 mm in BAV, 20–25 mm/m2 in Turner syndrome) | III |
|
| ||
| Severe aortic dilatation (> 45 mm in Marfan syndrome or other HCTD, > 50 mm in BAV, > 25 mm/m2 in Turner syndrome) | IV | |
|
| ||