Cardio-Obstetrics Fundamentals for Fellows-Congenital, Aortic and Valvular Disease in Pregnancy

Video Transcription

Video Summary

This module covers critical aspects of managing cardiovascular diseases in pregnancy, focusing on congenital heart disease (CHD), valvular heart disease, pulmonary hypertension, and aortopathy.<br /><br />Dr. Jeanette Lin reviews CHD in pregnancy, highlighting the growing adult congenital heart disease (ACHD) population due to surgical advances. Lesions vary from simple (e.g., atrial septal defects) to complex (e.g., tetralogy of Fallot, Eisenmenger syndrome), with risks escalating accordingly. ASD diagnosis in pregnancy involves echocardiography, and anticoagulation may be considered to reduce paradoxical embolism risk. Tetralogy of Fallot repaired patients tolerate pregnancy reasonably if compensated; coarctation requires lifelong monitoring due to associated risks like hypertension and aneurysms. Cyanosis and Eisenmenger syndrome predict high maternal-fetal risk and generally contraindicate pregnancy. Systemic right ventricle and Fontan physiology patients need expert management due to complex hemodynamics and thrombosis risk.<br /><br />Dr. Candice Silversides discusses valvular heart disease, focusing on mitral and aortic stenosis, which carry high maternal and fetal complication rates due to fixed obstructive lesions unable to accommodate pregnancy’s volume changes. Pulmonary stenosis and regurgitant lesions tend to be better tolerated. Treatment includes diuretics and beta-blockers; valve interventions during pregnancy are reserved for refractory cases and require specialized centers. Mechanical prosthetic valves pose significant risks due to thrombosis and anticoagulation challenges, while bioprosthetic valves have lower complication rates.<br /><br />Dr. Jasmine Grewal addresses pulmonary hypertension, which presents high maternal mortality though improved with modern therapies. Diagnosis hinges on right heart catheterization; echocardiography serves as screening. Increased pulmonary vascular resistance and right ventricular dysfunction worsen pregnancy outcomes. Multidisciplinary care, early initiation of targeted therapies, close surveillance, and careful delivery planning (prefer vaginal delivery with epidural anesthesia) are essential. Postpartum is high-risk; prolonged monitoring is critical.<br /><br />Dr. Melissa Russo focuses on pregnancy-associated aortopathy. Aortic dissections, though rare, are life-threatening emergencies requiring rapid diagnosis, often with CT imaging despite pregnancy concerns. Type A dissections usually require surgical repair; the timing of delivery depends on gestational age. Risk factors include genetic syndromes (e.g., Marfan, Loeys-Dietz, vascular Ehlers-Danlos), large aortic root size, and family history. Pre-pregnancy counseling, beta-blocker therapy, regular imaging, and multidisciplinary management guide care. Delivery is typically vaginal with regional anesthesia unless high risk warrants cesarean. Postpartum surveillance remains vital due to ongoing dissection risk.<br /><br />In sum, pregnancy management in cardiovascular disease requires tailored assessment of lesion type and severity, risk stratification, multidisciplinary collaboration, and vigilant monitoring to optimize maternal and fetal outcomes.

Keywords

cardiovascular diseases in pregnancy

congenital heart disease

valvular heart disease

pulmonary hypertension

aortopathy

adult congenital heart disease

echocardiography in pregnancy

maternal-fetal risk

mechanical prosthetic valves

multidisciplinary care