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Shunt Lesions

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Pregnancy and Congenital Heart Disease

Part of the book series: Congenital Heart Disease in Adolescents and Adults ((CHDAA))

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Abstract

Left-to-right shunt lesions are still the most common congenital heart disease in the adult population. During pregnancy, there is a reduction in systemic vascular resistances which is secondary to the growth of the fetoplacental unit, and left to right shunt decreases. Left-to-right shunt lesions are, thus, considered to be low risk. Despite this, risk of fetal and maternal complications is higher than in the general population. Vaginal delivery with epidural anesthesia is the mode of delivery generally recommended for left-to-right shunt lesions. Risk of transmission is present regardless of repair status. Fetal echocardiography should be offered in all types of shunt lesions.

When pulmonary arterial hypertension is present, the risk of complications increases for both mother and fetus, and despite advances in medical therapy Eisenmenger syndrome is still a contraindication for pregnancy. A multidisciplinary approach is then mandatory for all stages of pregnancy and puerperium.

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Abbreviations

ASD:

Atrial septal defect

AVSD:

Atrioventricular septal defect

CHD:

Congenital heart disease

C-section:

Caesarean section

IUGR:

Intrauterine growth retardation

LAVVR:

Left AV-valvular regurgitation

mWHO:

Modified World Health Organization

NYHA:

New York Heart Association

PAH:

Pulmonary arterial hypertension

PFO:

Persistent foramen ovale

ROPAC:

Registry of Pregnancy and Cardiac Disease

RS:

Risk score

VSD:

Ventricular septal defect

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Author information

Authors and Affiliations

  1. Integrated Hospital Vall d’Hebron-Sant Pau Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Antonia Pijuan-Domenech MD

  2. Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Maria Goya MD, PhD

Authors
  1. Antonia Pijuan-Domenech MD
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  2. Maria Goya MD, PhD
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Correspondence to Antonia Pijuan-Domenech MD .

Editor information

Editors and Affiliations

  1. Erasmus MC University Medical Center, Rotterdam, Gelderland, The Netherlands

    Jolien W. Roos-Hesselink

  2. Chelsea and Westminster Hospital, London, United Kingdom

    Mark R. Johnson

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Pijuan-Domenech, A., Goya, M. (2017). Shunt Lesions. In: Roos-Hesselink, J., Johnson, M. (eds) Pregnancy and Congenital Heart Disease. Congenital Heart Disease in Adolescents and Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-38913-4_9

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  • DOI: https://doi.org/10.1007/978-3-319-38913-4_9

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  • Online ISBN: 978-3-319-38913-4

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