Congenital Heart Disease

Clinical Case Download : Download full-size image A 26-year-old woman presents to her primary care clinic for management of hypertension and consideration of pregnancy. She had been taking lisinopril for several years for hypertension diagnosed in her early 20s, but self-discontinued this as she wanted to get pregnant. Her blood pressure is 150/90 in her right arm, 140/90 in her left arm, and 110/70 in her bilateral legs. Her exam shows a palpable radio-femoral delay, systolic click with a soft systolic murmur. Her workup includes a transthoracic echocardiogram which shows a bicuspid aortic valve, mild aortic insufficiency, and coarctation of the aorta with a gradient of 30 mmHg at the suprasternal notch. She was referred to adult congenital heart disease clinic. What does this new diagnosis of congenital heart disease mean for this female patient as she considers pregnancy? Does she warrant intervention? Medications? What are her long-term risks? An increasing number of patients with congenital heart disease (CHD) are surviving until adulthood because of advances in surgical and medical management in childhood. The impact of sex on risk stratification, counseling, management, outcomes, and mortality has received little attention in the CHD population compared to other cardiovascular diseases. As more women with CHD survive to reproductive age, special attention also needs to be directed toward contraception counseling, pregnancy risk stratification, and multidisciplinary management of pregnancy. A better understanding of the influence of sex on the adult congenital heart disease (ACHD) population is important to improve care of this growing population. Abstract The population of adults with congenital heart disease continues to grow as these individuals are surviving longer as a result of medical and surgical advances. Determining the role sex and gender plays on overall mortality, morbidity, transitions of care, reproductive health, and end-of-life decision-making is crucial to improving the comprehensive care of the adult with congenital heart disease. Preconception assessment is essential to understand the risk in pregnancy. Complications during pregnancy are predictable, and most women with congenital heart disease can have a successful pregnancy, labor, and delivery under the care of a multidisciplinary cardio-obstetric team.