Cardiac disease and pregnancy: hyper vigilance and extreme caution for optimal outcome


  • Naresh Dhawan Department of Anaesthesia, Army Hospital Research and Referral, Delhi, India
  • Rohin Kumar Department of Obstetrics and Gynecology, Army Hospital Research and Referral, Delhi, India
  • Reema Kumar Bhatt Department of Obstetrics and Gynecology, Army Hospital Research and Referral, Delhi, India



Bicuspid aortic valve, Multidisciplinary team, Single ventricle


Cardiac disease in pregnancy is a leading cause of maternal death in more so high-income countries. The armamentarium for winning this difficult battle involves shared decision-making with communication across the clinical team and the patient. There is limited clinical evidence concerning effective approaches to managing such complex care and moreover involvement of different specialists makes coordinated care challenging. Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1-2% of the population whereas a single ventricle is a rare congenital heart disease that accounts for less than 1% of all congenital heart diseases. We had two cases of pregnancy with bicuspid aortic valve in one case and the other with single ventricle. The involvement of multidisciplinary team involving cardiologist, cardiothoracic anaesthetist and fetal maternal medicine specialist resulted in good maternal and fetal outcome in both the cases.


Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387:462-74.

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2008;118(23):2395-451.

Elkayam U, Goland S, Pieper PG, Candice K. High-risk cardiac disease in pregnancy. Silversides J Am Coll Cardiol. 2016;68(4):396-410.

Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovas J Africa. 2016;27(2):89-94.

Fedak PW, Verma S, David TE, Leask RL, Weisel RD, Butany J. Clinical and pathophysiological implications of a bicuspid aortic valve. Circ. 2002;106:900-4.

Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010;55:2789-800.

Ward C. Clinical significance of the bicuspid aortic valve. Heart. 2000;83:81-5.

Braverman AC, Beardslee MA. The bicuspid aortic valve: pregnancy and the bicuspid aortic valve C.M. Otto, R.O. Bonow (Eds.), Valvular heart disease: a companion to Braunwald's heart disease. 3rd ed. Saunders/Elsevier: Philadelphia; 2009:169-186.

Canobbio MM, Cetta F, Silversides C, Warnes C, Aboulhosn J, Colman J. Pregnancy after Fontan operation: early and late outcomes. J Am Coll Cardiol. 2013;61:E427.

Inoue S, Masuyama H, Akagi T, Hiramatsu Y. Pregnancy and delivery in patients with Fontan circulation: a report of two cases. J Obstet Gynaecol Res. 2013;39:378-82.

Kim SY, Cho S, Choi E, Kim WH. Pregnancy and delivery in functional single ventricle patient; successful long-term outcome after right ventricle exclusion and Fontan operation. Korean Circ J. 2016;46(1):111-4.

Confidential enquiries into maternal deaths, 1997-1999. Br J Anaes. 2002:89:3:369-72.

Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 though 1996. J Am Coll Cardiol. 1998;31:1650-7.

Yentis SM, Steer PJ, Plaat F. Eisenmenger’s syndrome in pregnancy: maternal and fetal mortality in the 1990s. Br J Obstet Gynaecol. 1998;105:921-2.

Presbitero P, Somerville J, Stone S. Pregnancy in cyanotic congenital heart disease. Circ. 1994;89:2673-6.

Nelle M, Raio L, Pavlovic M, Carrel T, Surbek D, Meyer-Wittkopf M. Prenatal diagnosis and treatment planning of congenital heart defects-possibilities and limits. World J Pediatr. 2009;5:18-22.

Fernandes SM, Arendt KW, Landzberg MJ, Economy KE, Khairy P. Pregnant women with congenital heart disease: cardiac, anesthetic and obstetrical implications. Expert Rev Cardiovasc Ther. 2010;8:439-48.

Laas E, Lelong N, Thieulin AC, Houyel L, Bonnet D, Ancel PY, et al. EPICARD study group. Preterm birth and congenital heart defects: a population-based study. Pediatr. 2012;130(4):e829-3.






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