| Risk classification | Cardiac lesions |
| Class I No detectable increased risk of maternal mortality and no or minimal increase in maternal morbidity | - Uncomplicated mild pulmonary stenosis
- Ventricular septal defect
- Patent ductus arteriosus
- Mitral valve prolapse with no more than trivial mitral regurgitation
- Successfully repaired simple lesions (atrial or ventricular septal defect, patent ductus arteriosus, anomalous pulmonary venous drainage)
- Isolated ventricular extra-systoles and atrial ectopic beats
|
| Class II Small increased risk of maternal mortality or moderate increase in morbidity | - Unoperated atrial or ventricular septal defect
- Repaired tetralogy of Fallot
- Most arrhythmias
|
| Class II-III Some increased risk depending on patient | - Hypertrophic cardiomyopathy
- Native or tissue valvular heart disease not considered mWHO I or IV
- Repaired coarctation
- Marfan syndrome without aortic dilatation
- Bicuspid valve with aorta <45 mm
- Mild ventricular impairment
- Heart transplantation
|
| Class III Significantly increased risk of maternal mortality or severe morbidity | - Mechanical valve
- Systemic right ventricle
- Fontan circulation
- Unrepaired cyanotic heart disease
- Other complex congenital heart disease
- Marfan syndrome with aorta 40 to 45 mm
- Bicuspid aortic valve with aorta 45 to 50 mm
|
| Class IV Pregnancy is contraindicated | - Pulmonary hypertension
- Eisenmenger syndrome
- Systemic ventricular EF <30%
- Systemic ventricular dysfunction with NYHA class III-IV
- Severe mitral stenosis or symptomatic aortic stenosis
- Marfan syndrome with aorta >45 mm
- Bicuspid aortic valve with aorta >50 mm
- Native severe coarctation
- Prior peripartum cardiomyopathy with any residual impairment of ventricular function
|
