The team approach to pregnancy and congenital heart disease

The adult cardiologist is being called upon to see an increasing number of patients who have congenital heart disease. The incidence of this most common inborn defect is generally estimated at 0.8% of all births [1,2]. The advances in pediatric cardiology and surgery have resulted in a marked improvement in survival. Fifty years ago, only 25% of infants who had congenital heart disease (CHD) would survive their first year and now we expect about 85% to survive into adulthood [3]. There are no firm figures as to the real size of this adult population but it is estimated at 800,000 adult patients who have CHD in the United States. With an annual birth rate of 4 million [4], the United States will add another 28,000 infants who have CHD each year, with about 24,000 of these surviving into adulthood and joining the ever-growing list of adults who have congenital heart disease. Survival into adulthood certainly does not equate with cure of their congenital lesions [3,5] and they continue to face medical, surgical, and psychosocial obstacles [5-8]. Among these, some of the most challenging revolve around sexual function, reproductive issues, and pregnancy [9-11]. In the face of the improved survival among those who have congenital cardiac lesions and with the decreasing incidence of rheumatic heart disease, CHD is now the most common structural cardiac problem in women of childbearing age in North America and industrialized nations [12-14]. Most cardiac patients being seen in relation to pregnancy, therefore, have CHD and we must understand the effects of pregnancy on these patients and the risks faced by the mother and her offspring to choose the best plan for ongoing management.