Heart Disease

  • Vanita Suri
  • Pooja Sikka


Cardiac disease complicating pregnancy is seen in about 1–4% women. Due to effective treatment during childhood, the incidence of women with heart disease presenting during pregnancy is increasing. In developing countries like India, rheumatic heart disease still predominates, accounting for 60–80% of cardiac lesions in pregnancy. Congenital heart diseases are by far the commonest conditions in the west forming over 75% of heart diseases seen in pregnancy [1]. Pregnancy poses additional problem in women with underlying cardiac disease. A normal heart can adapt well to the hemodynamic alterations of pregnancy, whereas a diseased heart may not be able to do so and decompensate leading to heart failure. Ideally counseling and management of women of childbearing age with cardiac disease should start before pregnancy occurs. High-risk patients should be managed in specialized centers where multidisciplinary care is available. Diagnostic procedures and interventions should ideally be performed prior to pregnancy. Unfortunately in India, many women still are diagnosed to be having cardiac disease for the first time during pregnancy. This increases the morbidity and mortality associated with these disorders.


  1. 1.
    European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JS, Gohlke-Baerwolf C, Gorenek B, Iung B, Kirby M, Maas AH, Morais J, Nihoyannopoulos P, Pieper PG, Presbitero P, Roos-Hesselink JW, Schaufelberger M, Seeland U, Torracca L, ESC Committee for Practice Guidelines. ESC guidelines on the management of cardiovascular diseases during pregnancy: the task force on the Management of Cardiovascular Diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:3147–97.CrossRefGoogle Scholar
  2. 2.
    van Oppen AC, Stigter RH, Bruinse HW. Cardiac output in normal pregnancy: a critical review. Obstet Gynecol. 1996;87(2):310–8.CrossRefGoogle Scholar
  3. 3.
    Robson SC, Hunter S, Moore M, et al. Hemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study. Br J Obstet Gynaecol. 1987;94(11):1028–39.CrossRefGoogle Scholar
  4. 4.
    Robson SC, Dunlop W, Moore M, Hunter S. Combined Doppler and echocardiographic measurement of cardiac output: theory and application in pregnancy. Br J Obstet Gynaecol. 1987;94:1014–27.CrossRefGoogle Scholar
  5. 5.
    Stout KK, Otto CM. Pregnancy in women with valvular heart disease. Heart. 2007;93(5):552–8.CrossRefGoogle Scholar
  6. 6.
    Elkayam U. Pregnancy and cardiovascular disease. In: Zipes DP, Libby P, Bonow RO, Braunwald E, editors. Braunwald's heart disease: a textbook of cardiovascular medicine. 7th ed. Philadelphia, PA: WB Saunders; 2005. p. 1965–81.Google Scholar
  7. 7.
    Thorne S, MacGregor A, Nelson-Piercy C. Risks of contraception and pregnancy in heart disease. Heart. 2006;92:1520–5.CrossRefGoogle Scholar
  8. 8.
    Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, Kells CM, Bergin ML, Kiess MC, Marcotte F, Taylor DA, Gordon EP, Spears JC, Tam JW, Amankwah KS, Smallhorn JF, Farine D, Sorensen S. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515–21.CrossRefGoogle Scholar
  9. 9.
    Drenthen W, Boersma E, Balci A, Moons P, Roos-Hesselink JW, Mulder BJ, Vliegen HW, van Dijk AP, Voors AA, Yap SC, van Veldhuisen DJ, Pieper PG. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010;31:2124–32.CrossRefGoogle Scholar
  10. 10.
    Sawhney H, Aggarwal N, Suri V, Vasishta K, Sharma Y, Grover A. Maternal and perinatal outcome in rheumatic heart disease. Int J Gynaecol Obstet. 2003;80:9–14.CrossRefGoogle Scholar
  11. 11.
    Sawhney H, Suri V, Vasishta K, Gupta N, Devi K, Grover A. Pregnancy and congenital heart disease--maternal and fetal outcome. Aust N Z J Obstet Gynaecol. 1998;38:266–71.CrossRefGoogle Scholar
  12. 12.
    Aggarwal N, Suri V, Kaur H, Chopra S, Rohila M, Vijayvergiya R. Retrospective analysis of outcome of pregnancy in women with congenital heart disease: single-Centre experience from North India. Aust N Z J Obstet Gynaecol. 2009;49:376–81.CrossRefGoogle Scholar
  13. 13.
    Kaur H, Suri V, Aggarwal N, Chopra S, Vijayvergiya R, Talwar KK. Pregnancy in patients with tetralogy of fallot: outcome and management. World J Pediatr Congenit Heart Surg. 2010;1:170–4.CrossRefGoogle Scholar
  14. 14.
    Sikka P, Suri V, Aggarwal N, Chopra S, Bahl A, Vijayverghia R. Are we missing hypertrophic cardiomyopathy in pregnancy? Experience of a tertiary care hospital. J Clin Diagn Res. 2014:13–5.Google Scholar
  15. 15.
    Suri V, Aggarwal N, Kalpdev A, Chopra S, Sikka P, Vijayvergia R. Pregnancy with dilated and peripartum cardiomyopathy: maternal and fetal outcome. Arch Gynecol Obstet. 2013;287:195–9.CrossRefGoogle Scholar
  16. 16.
    Suri V, Aggarwal N, Keepanasseril A, Chopra S, Vijayvergiya R, Jain S. Pregnancy and Takayasu arteritis: a single Centre experience from North India. J Obstet Gynaecol Res. 2010;36:519–24.CrossRefGoogle Scholar
  17. 17.
    Suri V, Keepanasseril A, Aggarwal N, Vijayvergiya R, Chopra S, Rohilla M. Maternal complete heart block in pregnancy: analysis of four cases and review of management. J Obstet Gynaecol Res. 2009;35:434–7.CrossRefGoogle Scholar
  18. 18.
  19. 19.
    van Hagen IM, Boersma E, Johnson MR, Thorne SA, Parsonage WA, Escribano Subías P, Leśniak-Sobelga A, Irtyuga O, Sorour KA, Taha N, Maggioni AP, Hall R, Roos-Hesselink JW, ROPAC investigators and EORP team. Global cardiac risk assessment in the registry of pregnancy and cardiac disease: results of a registry from the European Society of Cardiology. Eur J Heart Fail. 2016;18:523–33.CrossRefGoogle Scholar
  20. 20.
    Sugrue D, Blake S, Troy P, et al. Antibiotic prophylaxis against infective endocarditis after normal delivery--is it necessary? Br Heart J. 1980;44(5):499–502.CrossRefGoogle Scholar
  21. 21.
    McFaul PB, Dornan JC, Lamki H, et al. Pregnancy complicated by maternal heart disease. A review of 519 women. Br J Obstet Gynaecol. 1988 Sep.;95(9):861–7.CrossRefGoogle Scholar
  22. 22.
    Petanovic M, Zagar Z. The significance of asymptomatic bacteremia for the newborn. Acta Obstet Gynecol Scand. 2001;80(9):813–7.CrossRefGoogle Scholar
  23. 23.
    Nishimura RA, Otto CM, Bonow RO, Carrabillo BA, Erwin JP, et al. Practice guideline. J Am Cardiol. 2014;63:e 57–185.CrossRefGoogle Scholar
  24. 24.
    Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, et al. ESC guidelines for the management of infective endocarditis: the task force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128.CrossRefGoogle Scholar
  25. 25.
    Aggarwal N, Suri V, Goyal A, Malhotra S, Manoj R, Dhaliwal RS. Closed mitral valvotomy in pregnancy and labor. Int J Gynaecol Obstet. 2005;88:118–21.CrossRefGoogle Scholar
  26. 26.
    Chopra S, Suri V, Aggarwal N, Rohilla M, Vijayvergiya R, Keepanasseril A. Ebstein's anomaly in pregnancy: maternal and neonatal outcomes. J Obstet Gynaecol Res. 2010;36:278–83.CrossRefGoogle Scholar
  27. 27.
    Suri V, Keepanasseril A, Aggarwal N, Chopra S, Bagga R, Sikka P, Vijayvergiya R. Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience. Eur J Obstet Gynecol Reprod Biol. 2011;159:320–3.CrossRefGoogle Scholar
  28. 28.
    Suri V, Sawhney H, Vasishta K, Renuka T, Grover A. Pregnancy following cardiac valve replacement surgery. Int J Gynaecol Obstet. 1999;64:239–46.CrossRefGoogle Scholar
  29. 29.
    Nishimura RA, Warnes CA. Anticoagulation during pregnancy in women with prosthetic valves: evidence, guidelines and unanswered questions. Heart. 2015;101:430–5.CrossRefGoogle Scholar
  30. 30.
    Saha PK, Joshi B, Suri V, Vijayvergiya R, Sikka P, Aggarwal N, Chopra S. Mitral valve thrombosis in pregnancy: successful restoration with thrombolysis. Am J Emerg Med. 2015;33:1325.e1–2.CrossRefGoogle Scholar
  31. 31.
    Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, et al. Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12:767–78.CrossRefGoogle Scholar
  32. 32.
    Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, et al. Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2733–79.CrossRefGoogle Scholar
  33. 33.
    Suri V, Aggarwal N, Kaur R, Chaudhary N, Ray P, Grover A. Safety of intrauterine contraceptive device (copper T 200 B) in women with cardiac disease. Contraception. 2008 Oct;78(4):315–8.CrossRefGoogle Scholar
  34. 34.
    World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed; 2015.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Vanita Suri
    • 1
  • Pooja Sikka
    • 1
  1. 1.Department of Obstetrics and GynecologyPGIMERChandigarhIndia

Personalised recommendations