Class 1: Risk is considered equivalent to that in the general population |
Uncomplicated, small, or mild pulmonary stenosis, patent ductus arteriosus, mitral valve prolapse |
Repaired simple lesions, eg, atrial septal defect, ventricular septal defect, patent ductus arteriosus, total anomalous pulmonary vein drainage |
Isolated premature ventricular beats and atrial ectopic beats |
Class 2: Small increased risk of morbidity and death |
Unoperated atrial septal defect |
Repaired tetralogy of Fallot |
Most arrhythmias |
Class 2 or 3: Moderate increased risk of morbidity and death, depending on the patient |
Mild left ventricular impairment |
Hypertrophic cardiomyopathy |
Native or tissue valvular heart disease (not including class IV valvular disease) |
Marfan syndrome without aortic dilation |
Heart transplant |
Class 3: Significantly increased risk of morbidity and death |
Mechanical valves |
Systemic right ventricle (ie, repaired congenital lesions) |
Cyanotic heart disease |
Post-Fontan operation |
Complex congenital heart disease |
Class 4: Pregnancy contraindicated |
Pulmonary hypertension |
Severe systemic ventricular dysfunction (left ventricular ejection fraction < 30%) |
Severe left heart obstruction |
Marfan syndrome with dilated aorta (> 40 mm) |
Previous peripartum cardiomyopathy with residual impaired left ventricular function |
Adapted from information in reference 33.