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ESC Congress: Task Force on the Management of Cardiovascular Diseases during Pregnancy

September 03, 2003

IMPORTANT: This press release accompanies a presentation given at the ESC Congress 2003.
Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology

Most pregnant women have normal hearts and most patients with heart disease are not contemplating pregnancy so many cardiologists and obstetricians are nervous about advising young women with heart disease because of their lack of experience.

Cardiologists more than any other specialists rely on evidence from clinical trials but there is no evidence basis to guide the clinician on the management and outcome of pregnancy in different cardiac conditions. Most drugs in use have become approved through lack of reported ill-effects (the exception is warfarin but there is no effective alternative).

Guidance comes from observational experience and a detailed knowledge of the cardiac condition in each patient which allows prediction of how the heavy demands on the cardiovascular system during pregnancy are likely to be handled.

Congenital heart disease has eclipsed rheumatic valve disease in prevalence thanks to successful surgery of previously fatal defects in infancy and the demise of rheumatic fever in the western world. More coronary artery disease is being seen as women defer their pregnancies.

Most women with congenital septal defects and leaking valves do well but narrowed valves, prosthetic valves, outgrown surgical conduits, cyanosis and fragile aortas are a worry and pulmonary hypertension is dangerous both by limiting blood flow and because it tends to get worse.

Cardiovascular complications of pregnancy which may afflict women without pre-existing heart disease include pre-eclampsia, arrhythmias, peripartum cardiomyopathy and pulmonary embolism. Women with pre-existing heart disease are not immune from these disorders which bring particular risk because of their reduced reserves.

High blood pressure is the commonest cardiovascular complication of pregnancy and remains one of the leading causes of both maternal and perinatal morbidity and mortality. Pre-eclampsia is a reversible systemic disease of pregnancy which may be superimposed on previous hypertension or appear de novo in later pregnancy. It is believed to be caused by release of a circulating factor from the placenta which causes generalised vasoconstriction, reduced organ perfusion and coagulation abnormalities but is still incompletely understood and usually reversed only by delivery of the baby.

Percutaneous intervention can be performed during pregnancy when essential. Balloon opening of narrowed valves, device closure of abnormal communications, radio frequency ablation of abnormal arrhythmic pathways and DC cardioversion can all be performed without disturbing the fetus. Ultrasound can be used to minimise irradiation.

The focus is on team work between all concerned: local general practitioners, physicians and obstetricians and regional teams of cardiologists, obstetricians, anaesthetists and geneticists as appropriate. Shared care is feasible for all but the highest risk patients and minimises travelling.

Celia Oakley MD FESC

European Society of Cardiology (ESC)