Navigating women with congenital heart disease during pregnancy: Management strategies and future directions

Figure 1 Cardio-obstetric team. ACHD: Adult congenital heart disease; EP: Electrophysiology; HF: Heart failure; L-D: Labor and delivery.

Figure 2 Overall summary of management of adult congenital heart disease during pregnancy. CO: Cardiac output; ACHD: Adult congenital heart disease; CV: Cardiovascular; SVR: systemic vascular resistance.

Figure 3 Modified World Health Organization classification for maternal risk associated with adult congenital heart disease. mWHO: Modified World Health Organization; PLE: Protein-losing enteropathy; CHD: Congenital heart disease; LV: Left ventricle; LVEF: Left ventricular ejection fraction; AS: Aortic stenosis; MS: Mitral stenosis; HCM: Hypertrophic cardiomyopathy; PS: Pulmonary stenosis; VSD: Ventricular septal defect; PDA: Patent ductus arteriosus; MVP: Mitral valve prolapse; ASD: Atrial septal defect; PAC: Premature atrial contraction; PVC: Premature ventricular contraction.

Figure 4 Risk stratification for women with ACHD during pregnancy. A: The risk of cardiac events per modified World Health Organization (mWHO) class; B: Composite risk comparison for cardiac events in women with adult congenital heart disease during pregnancy: mWHO class, CARPEG II, and ZAHARA scores. mWHO: Modified World Health Organization.

Figure 5 Adult congenital heart disease in women during pregnancy. A: Aortic stenosis, mitral stenosis, coarctation of the aorta; B: Unrepaired tetralogy of Fallot; C: Uncomplicated Ebstein anomaly; D: Extra-cardiac Fontan; E: Congenitally corrected transpositions of great arteries; F: Transposition of great arteries after Senning/mustard; G: Transposition of great arteries after arterial switch operation; H: Left to right shunt lesions (atrial septal defect, ventricular septal defect, and patent ductus arteriosus). ASD: Atrial septal defect; VSD: Ventricular septal defect; PDA: Patent ductus arteriosus; AO: Aorta; PA: Pulmonary artery; RV: Right ventricle; RA: Right atrium; LV: Left ventricle; LA: Left atrium; SVC: Superior venacava; IVC: Inferior venacava; TGA: Transposition of the great arteries arteries.

Figure 6 Postpartum care for women with adult congenital heart disease. CVD: Cardiovascular disease; IUGR: Intra-uterine growth retardation.