[Pregnancy and congenital heart defects].

With advanced diagnostic and therapeutic techniques in pediatric cardiology and cardiac surgery, pregnancy can be an option for patients with congenital heart disease. A low overall maternal mortality and a healthy pregnancy require interdisciplinary cooperation between the cardiologist, obstetrician and general practitioner caring for the mother. Treatment and outcome will depend on the type of cardiac malformation, on the functional impairment of the maternal heart (heart failure and/or cyanosis) and on the status of the fetus, with evidence of a better outcome for patients treated in specialized centers. However, even with recent advances in treatment, for women with primary pulmonary hypertension, Eisenmenger's syndrome, left heart obstruction of Marfan syndrome, pregnancy remains associated with a high maternal mortality. Therefore, these are conditions in which pregnancy is still absolutely contraindicated and a patient should be counselled to terminate the pregnancy. The risk of an inherited recurrence of a congenital heart disease is difficult to assess in an individual case because the majority of cardiac malformations are caused by multifactored variables. But for some types of malformations (i.e., atrioventricular canal, Morbus Fallot) the incidence of cardiac malformation in the offspring of affected parents is slightly higher compared to the general population. Consequently, all patients with congenital heart disease should be offered genetic counselling and fetal echocardiography. In general, pregnancy in women with congenital heart disease has no significant long-term adverse effects and a second pregnancy is possible in the majority of the cases.