Evaluation of Pregnancy risk factors in Women with Tetralogy of Fallot and cyanotic congenital heart disease (narrative review)

The adult patient's population with congenital heart disease (CHD) is rapidly growing due to progress in cardiologic and surgical interventions. Almost a million adult with CHD are living in western world. The present study was performed with aim to evaluate the newest studies to determine the cardiac assessment before pregnancy, best diagnostic methods, and determining the cases of pregnancy contraindication in congenital heart disease.

In this narrative review article, the most recent researches, reviews, guideline articles, gynecology and cardiovascular surgery reference books were selected and evaluated by the keywords of pregnancy, congenital disease and their equivalents; then, the most important and strongest diagnostic and therapeutic recommendations were provided. 20 articles were used in this study consisted of the related articles in the PubMed, Scopus, Google scholar databases during 1997 to 2014.

Cardiac contraindications to pregnancy in CHD included severe pulmonary hypertension, severe obstructive lesions, class III/IV congestive heart failure and Mar fan syndrome with aortic root >40 mm and sever PI and right ventricle failure. Echocardiography is the preferred imaging modality for guiding the treatment care of these patients.

Preconception evaluation is essential for genetic consultation, identifying/optimizing medical and surgical ideals before pregnancy in order to improve outcomes. A multidisciplinary approach with collaboration between gynecology, anesthesiology, cardiology and cardiac surgery at a specialized center is required for treatment management of these patients.