Coronary angiography and percutaneous interventions in pregnancy

Pregnancy and the need for cardiac catheterization poises a unique challenge that requires the balance of risk and benefit both to the mother and the fetus. Fortunately, the need for radiological invasive procedures for cardiac diagnosis has been markedly reduced with the widespread growth in imaging technology using non-ionizing energies such as ultrasound for diagnosis of underlying cardiac pathology. As the age of active childbearing has increased in many countries, an increasing overlap has developed with the childbearing overlapping the early years of acute coronary artery disease. Both acute coronary syndromes and classic congenital valve disorders are increasingly being treated successfully with invasive cath lab technologies that require some degree of risk to the pregnancy. We review the pathophysiology of both valvular and coronary pathologies that may become symptomatic or acutely decompensated and require consideration for invasive cardiac therapy. Potential risks both from radiation, acute medication use and potential need for longer term oral medications resulting from the invasive cardiac procedures are reviewed. Final specific measures to reduce the risks most pertinent to pregnancy are discussed. While risks are present during pregnancy that are unique, emergently indicated invasive cardiac procedures should not be denied or delayed solely on the pregnant state as many of these procedures have highly time responsive benefits that can be lost by irrational delays.