Maternal Heart Conditions With An Unacceptably High Risk In Pregnancy?

A 32-year-old woman with a history of congenital heart disease is planning to start a family. She has no other significant medical history and is currently symptomatically stable on a small dose of loop diuretic.

Question
Which one of the following conditions is associated with an unacceptably high risk in pregnancy?
A Corrected tetralogy of Fallot
B Perimembranous ventricular septal defect
C Secundum atrial septal defect
D Coarctation of the aorta
E Pulmonary hypertension of any cause

Answer:
E. Pulmonary hypertension of any cause

Discussion: Pulmonary hypertension of any cause is associated with a 50% maternal mortality.
Other high-risk cardiac conditions are
severe mitral, pulmonary or aortic stenosis and
Marfan’s syndrome with a dilated aortic root.

Intracardiac shunts without pulmonary hypertension are relatively safe but require closer follow-up.

Operated tetralogy of Fallot without residual pulmonary stenosis is lower risk.

Coarctation is associated with dissection and is intermediate risk.