[Heart disease and pregnancy]

Pregnancy is associated with important haemodynamic changes that increase during delivery and may decompensate an underlying heart disease. Some situations (fortunately rare) are at very high risk and can contra-indicate pregnancy (Eisenmenger syndrome, severe stenotic left heart valve, severely dilated aorta and severe left ventricular dysfunction). Women with less severe disease can have a pregnancy with specific follow-up (shunt lesions, operated tetralogy of Fallot, mecanical valve). Peri-partum cardiomyopathy is an entity specific to pregnancy because of timing of its diagnosis. The presence of heart disease during pregnancy raises a number of different problems. This underlines the need for a multidisciplinary approach at each phase: before and during pregnancy as well as during the post-partum period. Modalities of delivery should be discussed and planned taking into account the type of heart disease and its tolerance towards the end of pregnancy.