ACQUIRED HEART-DISEASE IN PREGNANCY

Understanding of the mechanisms of cardiovascular and hemodynamic adap tation during pregnancy helps to prevent: or manage complications in c ardiac patients during gestation. Manifestations of coronary heart dis ease are exceptional during pregnancy and delivery. The same is true o f disorders of the pericardium. Peripartal cardiomyopathy is a myocard ial disorder of undetermined cause occurring shortly before, during or after delivery, which may take a fatal course. Hypertrophic obstructi ve or non-obstructive cardiomyopathy is compatible with gestation and delivery without serious complications in most cases. Rheumatic mitral stenosis was the most common cardiac disorder until the 1950s. Nowada ys it is rarely seen in this country. Surgical and other interventiona l therapies have greatly changed the outlook in pregnant women with va lvular heart disease. A highly controversial issue is heart valve repl acement in young women and management of anticoagulation during pregna ncy. Like any other drug therapy, anticoagulation during gestation req uires careful weighing of the benefit for the mother against toxic and teratogenic effects for the fetus. In women with heart disease the ma nagement of pregnancy should start, if possible, before conception. Th orough counseling and proper planning of pregnancy and of therpeutic m easures is essential in order to avoid or manage complications.