{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T22:50:03Z","timestamp":1784242203000,"version":"3.55.0"},"reference-count":52,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Pregnancy and delivery in patients with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH) carry a very high risk for maternal and foetal complications and are contraindicated according to the guidelines. In the last decades, when an available modern PAH-targeted medication therapy and a new management concept improved patients\u2019 well-being and survival, some PAH-CHD females decided to conceive. Of note, despite advanced treatment and modern healthcare system possibilities, dealing with pregnancy in a diverse PAH-CHD population is still challenging. The study aimed to share our experience with PAH-CHD pregnancies and discuss the risk assessment and current management of these patients with the combination of two rare diseases. Materials and Methods: The retrospective search of pulmonary hypertension and adult CHD registries in our hospital was performed, selecting all patients with CHD and PAH who conceived pregnancy from 2013 to 2021. Baseline demographic, clinical, and functional characteristics and clinical outcomes were collected. Results: Thirteen pregnancies in eight patients with PAH-CHD resulted in seven live births, three miscarriages, and three terminations. Five women were diagnosed with Eisenmenger syndrome (ES) and three with residual PAH after CHD repair. Before pregnancy, half of them were in WHO functional class III. Seven (87.5%) patients received targeted PAH treatment with sildenafil during pregnancy. In addition, the two most severe cases were administered with iloprost during peripartum. Three ES patients delivered preterm by Caesarean section under general anaesthesia. No neonatal mortality was reported. Maternal complications were observed in half of our cases. One patient died 12 days after the delivery in another hospital due to deterioration of heart failure. Conclusions: On the basis of our clinical experience, we conclude that pregnancy and delivery carry a high risk for maternal complications and should be avoided in women with PAH-CHD. The individualised approach of multidisciplinary care and appropriate monitoring are mandatory in reducing the risk of adverse outcomes.<\/jats:p>","DOI":"10.3390\/medicina58040476","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T21:29:36Z","timestamp":1648416576000},"page":"476","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Pregnancy in Congenital Heart Disease, Complicated by Pulmonary Arterial Hypertension\u2014A Challenging Issue for the Pregnant Woman, the Foetus, and Healthcare Professionals"],"prefix":"10.3390","volume":"58","author":[{"given":"Virginija","family":"Rudien\u0117","sequence":"first","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"},{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3894-5598","authenticated-orcid":false,"given":"Lina","family":"Kaplerien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"},{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dovil\u0117","family":"Jan\u010dauskait\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"},{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilija","family":"Me\u0161k\u0117n\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"},{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egl\u0117","family":"Palevi\u010di\u016bt\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"},{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Laukyt\u0117-Sl\u0117nien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Gasi\u016bnait\u0117","sequence":"additional","affiliation":[{"name":"Centre of Anaesthesiology, Intensive Therapy and Pain Management, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Rama\u0161auskait\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"},{"name":"Centre of Obstetrics and Gynaecology, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4331-5179","authenticated-orcid":false,"given":"Elena","family":"Jurevi\u010dien\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"},{"name":"Centre of Pulmonology and Allergology, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Gumbien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"},{"name":"Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"},{"name":"Centre of Heart and Chest Surgery, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1801913","DOI":"10.1183\/13993003.01913-2018","article-title":"Haemodynamic definitions and updated clinical classification of pulmonary hypertension","volume":"53","author":"Simonneau","year":"2019","journal-title":"Eur. 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