SPC365

Complex Congenital Heart Disease in Pregnancy: Real-World Outcomes in mWHO III–IV Women Followed by a Dedicated Heart–Team

Session: Sessão de Posters 17 - O género importa em cardiologia
Speaker: Fernando Nascimento Ferreira

Congress: CPC 2026
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.7 Pregnancy and Cardiovascular Disease
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Fernando Ferreira; Mariana Caetano Coelho; Vera Ferreira; Tânia Mano; Rita Moreira; Tiago Rito; Pedro Oom; Rui Cruz Ferreira; Lidia de Sousa

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Background: Pregnancy imposes haemodynamic and prothrombotic stress, and women with complex congenital heart disease (CHD) classified as modified WHO (mWHO) class III or IV face increased risks of adverse obstetric and neonatal outcomes,</span></span></span> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">requires coordinated multidisciplinary management. However available data in the patients remain limited.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Methods: We performed a retrospective descriptive study of consecutive pregnancies in women with mWHO III-IV CHD followed by a multidisciplinary pregnancy&ndash;heart team between 2020 and 2024. Baseline characteristics, maternal and obstetric outcomes were systematically collected. Haemodynamic status during pregnancy was assessed by NYHA functional class and serial NT-proBNP measurements. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Results: 12 women and 13 pregnancies were included (39.5% mWHO IV), with 11 completed deliveries. Two pregnancies were electively interrupted, one due to patient decision and another after counselling, owing to failing Fontan circulation. The mean maternal age was 29.8&plusmn;5.2 years; 62% had prior corrective and 46% palliative surgery. Diagnoses included systemic right ventricle after atrial switch for D-TGA (42%), Fontan circulation (17%), repaired TOF with significant residual lesions (17%), unrepaired complex cyanotic CHD (8.3%), and atrioventricular septal defects (AVSD) with AV valve regurgitation or mechanical prosthesis (25%). Significant valvular disease was present in 62%, and previous arrhythmia in 31%. At baseline, most patients were NYHA class I&ndash;II and median NTproBNP was 126 (65-377) pg/mL with minor changes during pregnancy.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Among the completed pregnancies, the median gestational age at delivery was 39 (38&ndash;40) weeks. Caesarean section was performed in 45%. Maternal complications included decompensated heart failure in 2 patients (D-TGA with pulmonary baffle stenosis and failing Fontan) and postpartum cardiovascular hospitalisation in a patient with AVSD and mechanical left AV valve stenosis by mismatch. Obstetric complications occurred in 36%, 2 patients with AVSD, one with severe left AV valve regurgitation and another with left mechanical prosthetic mismatch, had postpartum haemorrhage, and 1 patient with D-TGA and pulmonary baffle stenosis had a hypertensive disorder. Neonatal outcomes were favourable; one neonate, born to a mother with unrepaired complex cyanotic CHD, had low birth weight and congenital heart disease and died at two months old. No maternal deaths occurred.</span></span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Conclusion: This cohort of women with mWHO III&ndash;IV CHD managed within a specialised multidisciplinary programme, pregnancy was feasible with acceptable maternal and neonatal outcomes, although cardiac and obstetric complications remained common. These findings highlight the importance of meticulous pre-pregnancy counselling, individualised risk stratification, and close surveillance throughout gestation in high-risk congenital heart disease.</span></span></span></p>