Congenital Lesions

Question 0

Ventricular septal defects

Answer 0

If < 1.25 cm pulmonary hypertension and heart failure are unlikely

Pregnancy well tolerated

Risk of paradoxical embolism

Question 1

Atrial septal defects

Answer 1

Well tolerated in pregnancy

If found prior to pregnancy better to consider closure first

Risk of paradoxical embolism

Question 2

PDA

Answer 2

Well tolerated also with left to right shunt.

Question 3

Tetralogy of Fallot

Answer 3

Cyanotic congenital heart disease

Four features 
VSD
pulmonary artery stenosis 
Overriding aorta
Right ventricular hypertrophy

Question 4

Tetralogy of Fallot 2

Answer 4

15% women have deletion of chromosome 22q11.

Increased chance of fetus with congenital heart disease

Question 5

Tetralogy and pregnancy

Answer 5

Right to left shunt worsen and cyanosis increased if uncorrected

Most women have had it corrected

Pregnancy is well tolerated if ventricular function is good

Possible pulmonary regurgitation occasionally needing diuretics or bed rest

Question 6

Fontan procedure

Answer 6

Single ventricle

Increases thrombotic risk

Cyanosis develops quickly if hypotension

30% risk of miscarriage

Question 7

Eisenmenger syndrome

Answer 7

Mortality 20-40%

Poor fetal outcome when cyanosis, low oxygen saturation and polycythemia

Mortality mainly postnatal

Question 8

Marfan syndrome

Answer 8

Major risk - aortic dissection, which is greater if aortic root > 4 cm

Regular echoes

Beta blockers

Consider c/s for dilated aortic roots

Highest risk is peripartum and immediate post partum

Genetics during pregnancy because it’s autosomal dominant 1:2 chances for fetus