[II-JCK04-6] Pregnancy, What is the challenge in Adult Congenital Heart Disease with Heart Failure?
Knowledge of the risks associated with cardiovascular problem in congenital heart disease during pregnancy and their management in pregnant women who suffer from serious pre-existing conditions is essential for advising patients before pregnancy. So, all women with known congenital heart disease who wish to embark on pregnancy require timely pre-pregnancy counselling. Informed maternal decision making is crucial and there is a clear need for individualized care, taking into account not only the medical condition, but also the emotional and cultural context, psychological issues, and ethical challenges.
Especially, in high risk or possible contraindication of pregnancy, the exact risk of pregnancy and the necessity of careful planning of pregnancy should be discussed. The risk of pregnancy depends on the underlying heart defect as well as on additional factors such as pulmonary hypertension, ventricular dysfunction, unfavorable functional class, and cyanosis. Maternal cardiac complications are more frequent in complex congenital heart diseases, and heart failure. The patients should be advised the pre-pregnancy management includes the modification of existing heart failure medications to avoid fetal harm. Additional bromocriptine to standard heart failure therapy may improve LV recovery and clinical outcome in severe peri-partum heart failure.
A multidisciplinary management plan should be constructed and discussed with the patient and family before pregnancy, during pregnancy, and after pregnancy.
Especially, in high risk or possible contraindication of pregnancy, the exact risk of pregnancy and the necessity of careful planning of pregnancy should be discussed. The risk of pregnancy depends on the underlying heart defect as well as on additional factors such as pulmonary hypertension, ventricular dysfunction, unfavorable functional class, and cyanosis. Maternal cardiac complications are more frequent in complex congenital heart diseases, and heart failure. The patients should be advised the pre-pregnancy management includes the modification of existing heart failure medications to avoid fetal harm. Additional bromocriptine to standard heart failure therapy may improve LV recovery and clinical outcome in severe peri-partum heart failure.
A multidisciplinary management plan should be constructed and discussed with the patient and family before pregnancy, during pregnancy, and after pregnancy.