Managing Pregnancy in a Patient With Unrepaired Congenital Heart Disease (JACC Case Reports November 2025)-Article: Managing Pregnancy in a Patient With Unrepaired Congenital Heart Disease

Article: Managing Pregnancy in a Patient With Unrepaired Congenital Heart Disease

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This case report details the multidisciplinary management of a 38-year-old pregnant woman with an unrepaired congenital heart defect, specifically a transitional atrioventricular septal defect with moderate left AV valve regurgitation. Presenting at 20 weeks gestation with palpitations and a heart murmur, evaluation confirmed the cardiac anomaly and moderate valve insufficiency, though biventricular function was preserved.<br /><br />Given her condition, she was closely managed by a team including cardiologists, maternal-fetal medicine specialists, anesthesiologists, and nursing staff. Key decisions, such as withholding anticoagulation despite hypercoagulability concerns, were carefully balanced against risks like bleeding and low thromboembolic risk in the absence of cyanosis or right-to-left shunting. Prophylaxis for infective endocarditis was discussed though not formally indicated per guidelines.<br /><br />A critical component of care was development of a detailed, individualized delivery plan embedded in the institution’s electronic medical record (EMR) system via an “Our Practice Advisory” (OPA) banner alert. This ensured real-time visibility and ongoing updates accessible by all providers throughout prenatal care, delivery, and postpartum phases, enhancing coordination and safety. The plan included delivery mode recommendations, anesthesia considerations, intrapartum monitoring protocols, use of filtered IV lines, and telemetry during labor.<br /><br />The patient developed pre-eclampsia at 37 weeks and underwent an uncomplicated induced vaginal delivery. Postpartum, she remained stable without arrhythmias or volume overload and was referred for surgical repair of the defect.<br /><br />The report emphasizes that unrepaired congenital cardiac defects pose increased maternal-fetal risks such as preeclampsia and peripartum heart failure, necessitating proactive multidisciplinary collaboration. Embedding delivery plans within the EMR optimizes communication across specialties, reduces risk, and ensures continuity of care. This approach highlights a practical, technology-integrated strategy to improve outcomes for pregnant patients with complex congenital heart disease.

Keywords

congenital heart defect

atrioventricular septal defect

pregnancy

multidisciplinary management

maternal-fetal medicine

electronic medical record

delivery planning

pre-eclampsia

cardiac valve regurgitation

peripartum care