Women born with the obstructive cardiac lesions of aortic stenosis, coarctation of the aorta and mitral stenosis may be relatively asymptomatic through their childbearing years. However, the hemodynamic changes of pregnancy of volume expansion, increased preload and decreased afterload may cause the patient to become symptomatic. Those caring for women born with these cardiac lesions should look for signs of early decompensation and anticipate problems before they occur. Aortic stenosis may be mild or moderate and the woman may first become symptomatic after the hemodynamic changes of pregnancy ensue she may develop pulmonary edema or heart failure as the pregnancy progresses. This certainly can be managed expectantly in this patient population. The woman with an uncorrected coarctation of the aorta may be at risk of decreased placental blood flow, although a woman of childbearing age with an unrepaired coarctation of the aorta, often has a mild coarctation with extensive collateral flow. She is also at risk for hypertension developing during pregnancy along with the woman who has undergone repair prior to conception. Mitral stenosis is of concern and in the past has been predominantly of rheumatic origin. It may remain clinically silent until a woman becomes pregnant. The risks of this lesion include pulmonary edema and atrial fibrillation resulting in thromboembolic phenomenon due to the hypercoagulable state of pregnancy. It is best to identify obstructive cardiac lesions prior to pregnancy, but careful management during pregnancy can facilitate a safe and successful pregnancy in these patients. If patients are evaluated prior to conception and found that they have critical valve lesions, they may have a less complicated pregnancy if correction is recommended prior to conception.
- Aortic stenosis
- Cardiovascular complications
- Congenital coarctation of the aorta
- Mitral stenosis
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Cardiology and Cardiovascular Medicine