Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
With recent advances in cardiovascular and neonatal medicine, the number of patients with congenital heart disease（CHD）who become childbearing age has increased, and the range and severity of heart diseases with which pregnancy and delivery are possible is expanding. The cardiocirculatory changes associated with pregnancy and delivery are marked, and in some diseases and conditions, the maternal and fetal risks are high. Therefore, understanding peripartum physiological changes how and when they occur is very important in order to manage pregnancy with CHD. Circulating plasma volume increases during the first and second trimester and becomes 1.5-fold around week-30. Because of such increased preload, patients with stenotic lesions, pulmonary hypertension and/or severe cardiac dysfunction, need more careful attention, especially for heart failure. On the other hand, vascular resistance is decreased during pregnancy. Thus, a mild-to-moderate degree of shunt or regurgitant diseases are well-tolerated for the pregnancy. The aortic wall becomes weaker due to hormonal effects and the risk of aortic dissection increases during pregnancy. Recently, aortopathy is found patients with CHD, such as tetralogy of Fallot（TOF）, transposition of the great arteries and single ventricle. The patients with already enlarged aorta should be followed in respect to its diameters during the peripartum period. Physiological stresses increased by pregnancy and delivery can have an effect on long-term cardiac function in some women with CHD. We reported that a dilated right heart condition tended to further progress throughout pregnancy among women with TOF. The study of cardiac MRI revealed that the larger right ventricular the woman had before pregnancy, the more increase of right heart size she showed long after her delivery. We had better consider pregnancy effect on long-term prognosis among those women, as well as pregnancy outcomes.