Stress Echocardiography for Prepregnancy Counselling... Ready for Prime Time?

Cardiologists dealing with young individuals with moderate or severe forms of structural heart disease often face the challenge of deciding appropriate type and timing for interventions. The age at first surgery, the expected life of a valvular prosthesis or graft, and the surgical risk of each sternotomy will significantly impact a patient’s life expectancy and must be considered at the time of shared decision making. As if it were not complicated enough, female patients must also weigh in family planning and the risks that may come with a pregnancy, making this an even more challenging decision. Utility of exercise-stress echocardiography for pre-pregnancy risk stratification in women with left heart obstructionCanadian Journal of CardiologyPreviewLeft heart obstruction is a high maternal CV risk state with severe obstruction classified as modified World Health Organisation risk III-IV (mWHO≥3), depending on symptomatic status, associated with a minimum cardiac event rate of 1-in-5.1 Guidelines recommend expert pre-conception counselling, with care during pregnancy provided in an expert centre for pregnancy and cardiac disease. A variety of risk stratification tools (CARPREG II, ZAHARA) have been proposed to inform shared decision-making. Full-Text PDF