What is a significant risk associated with long-standing congenital heart disease in pregnancy?

Long-standing congenital heart disease in pregnancy poses significant risks, one of which is increased pulmonary vascular resistance. As the pregnancy progresses, hemodynamic changes occur, including an increase in blood volume and cardiac output. In women with congenital heart defects, particularly those involving the left-to-right shunts, these changes can lead to volume overload and pulmonary hypertension.

Increased pulmonary vascular resistance can result because the normal adaptations associated with pregnancy—like increased blood flow to the lungs—may exacerbate existing pulmonary vascular pathology. Conditions such as Eisenmenger syndrome or other forms of right-to-left shunt can develop, leading to serious complications such as worsening right heart failure and reduced oxygen delivery to both the mother and fetus. Therefore, monitoring and managing these patients during pregnancy is crucial to minimize complications associated with increased pulmonary vascular resistance.

Understanding this connection helps practitioners provide better care in managing pregnant patients with congenital heart disease, focusing on the potential escalation of pulmonary pressures and the implications for maternal and fetal health.