Table 5. WHO class IV.

• Pulmonary arterial hypertension of any cause

• Severe systemic ventricular dysfunction (LVEF < 30%, NYHA III–IV)

• Previous peripartum cardiomyopathy with any residual impairment of left ventricular function

• Severe mitral stenosis, severe symptomatic aortic stenosis

• Marfan syndrome with aorta dilated > 45 mm

• Aortic dilation > 50 mm in aortic disease associated with bicuspid aortic valve

• Native severe coarctation