2018 ESC Gls Pregnancy Mastercopy for Publication Approval

DocuSign Envelope ID: 8FB0189D-BFD3-4849-A970-EDB185ABC245 CONFIDENTIAL ESC GUIDELINES European Heart Journal ... doi:10.1093/eurheartj/... 1 2 2018 ESC Guidelines for the management of 3 cardiovascular diseases during pregnancy 4 5 The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the 6 European Society of Cardiology (ESC) 7 8 Endorsed by: (Will be finalized and filled in later) 9 10 11 Authors/Task Force Members: Vera Regitz-Zagrosek* (Chairperson) (Germany), Jolien W. Roos- 12 Hesselink* (Co-Chairperson) (The Netherlands), Johann Bauersacks (Germany), Carina Blomström- 13 Lundqvist (Sweden), Renata Cífková (Czech Republic), Michele De Bonis (Italy), Bernard Iung 14 (France), Mark R. Johnson (UK), Ulrich Kintscher (Germany), Peter Kranke 1 (Germany), Irene Lang 15 (Austria), Joao Morais (Portugal), Petronella G. Pieper (The Netherlands), Patrizia Presbitero (Italy), 16 Susanna Price (UK), Giuseppe M. C. Rosano (UK/Italy), Ute Seeland (Germany), Tommaso 17 Simoncini 2 (Italy), Lorna Swan (UK), Carole A. Warnes (USA) 18 19 20 Document Reviewers: 21 Christi Deaton (CPG Review Coordinator) (UK), Iain A. Simpson (CPG Review Coordinator) (UK), 22 Reviewers’ list will be added later by Gls department 23 First Name Last Name (Initials are allowed) (country), ............... 24 25 26 27 28 29 30 31 32 33 The disclosure forms of all experts involved in the development of these guidelines are available on 34 the ESC website www.escardio.org/guidelines 35 36 37 Keywords: 38 Guidelines, pregnancy, cardiovascular disease, risk assessment, management, congenital heart 39 disease, valvular heart disease, hypertension, heart failure, arrhythmia, pulmonary hypertension, 40 aortic pathology, cardiomyopathy, drug therapy, pharmacology. 41 42 43 44 45 46 47 48 49 50 51 DocuSign Envelope ID: 8FB0189D-BFD3-4849-A970-EDB185ABC245 Page 2 of 153 ESC Guidelines CONFIDENTIAL DRAFT V2_05042018 52 53 * Corresponding authors: Vera Regitz-Zagrosek , Charité Universitaetsmedizin Berlin; Institute for Gender in Medicine, Hessische Str 3-4, 10115 Berlin, Germany, Tel: +49 30 450 525 288, Fax: +49 30 450 7 525 288, Email: [email protected] Jolien W. Roos-Hesselink , Erasmus Medical Center Rotterdam; Department of Cardiology, Dr Molewaterplein 40, 3015CGD, Rotterdam, Netherlands, Tel: +31 10 7032432, Email: [email protected] ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers : listed in the Appendix. (The appendix is currently being finalized separately by the Guidelines department) 1 Representing the European Society of Anaesthesiology 2 Representing the European Society of Gynecology ESC entities having participated in the development of this document: Associations : Acute Cardiovascular Care Association (ACCA), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA). Councils : Council on Cardiovascular Nursing and Allied Professions, Council on Cardiovascular Primary Care, Council on Hypertension, Council on Valvular Heart Disease Working Groups : Aorta and Peripheral Vascular Diseases, Cardiovascular Pharmacotherapy, Cardiovascular Surgery, Grown-up Congenital Heart Disease, Myocardial and Pericardial Diseases, Pulmonary Circulation and Right Ventricular Function, Thrombosis. The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC ([email protected]). Disclaimer . (will be the same for all 2018 ESC Guidelines and will be added by the Guidelines department) … © The European Society of Cardiology 2018. All rights reserved. For permissions please email: [email protected]. 54 55 56 DocuSign Envelope ID: 8FB0189D-BFD3-4849-A970-EDB185ABC245 Page 3 of 153 ESC Guidelines CONFIDENTIAL DRAFT V2_05042018 57 Table of contents 58 Table of contents ....................................................................................................... 3 59 List of tables .............................................................................................................. 8 60 List of abbreviations .................................................................................................. 8 61 1. Preamble ......................................................................................................... 11 62 2. Introduction .................................................................................................... 112 63 2.1 Why do we need new guidelines on the management of 64 cardiovascular diseases in pregnancy? ........................................................ 112 65 2.2 New format of the guidelines .............................................................. 12 66 2.3 Why these guidelines are important? ................................................ 112 67 2.4 Methods .............................................................................................. 13 68 2.5 What is new? ...................................................................................... 14 69 3. General considerations .................................................................................... 16 70 3.1 Epidemiology ...................................................................................... 16 71 3.2 Physiological adaptations to pregnancy .............................................. 16 72 3.3 Pre-pregnancy counselling ................................................................. 17 73 3.3.1 Risk of maternal cardiovascular complications…………………....18 74 3.3.2 Risk of obstetric and offspring complications……………………...19 75 3.3.3 Pregnancy heart team ……………………………………………….20 76 3.4 Cardiovascular diagnosis in pregnancy ............................................ 211 77 3.5 Genetic testing and counselling ........................................................ 244 78 3.6 Fetal assessment .............................................................................. 255 79 3.7 Interventions in the mother during pregnancy ................................... 266 80 3.7.1 Percutaneous therapy……………………………………………….26 81 3.7.2 Cardiac surgery with cardiopulmonary bypass…………………...27 82 3.8 Timing and mode of delivery: risk for mother and child ..................... 277 83 3.9 Infective endocarditis .......................................................................... 31 84 3.9.1 Prophylaxis…………………………………………………………....31 85 3.9.2 Diagnosis and risk assessment……………………………………..31 86 3.9.3 Treatment… ……………………………………………………...31 87 3.10 Methods of contraception and termination of pregnancy, and 88 in vitro fertilization ......................................................................................... 332 89 3.10.1 Methods of contraception………………………………………….32 90 3.10.2 Sterilization………………………………………………………….32 91 3.10.3 Methods of termination of pregnancy…………………………….33 92 3.10.4 In vitro fertilization…………………………………………............33 93 3.11 Recommendations .............................................................................. 34 94 4. Congenital heart disease and pulmonary hypertension .................................... 36 DocuSign Envelope ID: 8FB0189D-BFD3-4849-A970-EDB185ABC245 Page 4 of 153 ESC Guidelines CONFIDENTIAL DRAFT V2_05042018 95 4.1 Introduction ......................................................................................... 36 96 4.2 Pulmonary hypertension and Eisenmenger syndrome ........................ 36 97 4.2.1 Pulmonary hypertension………………………………………….....36 98 4.2.2 Eisenmenger syndrome…………………………………………..…38 99 4.2.3 Cyanotic heart disease without pulmonary hypertension……..…39 100 4.3 Specific congenital heart defects ........................................................ 39 101 4.3.1 Left ventricular outflow tract obstruction………………………..…39 102 4.3.2 Atrial septal defect…………………………………………………..39 103 4.3.3 Ventricular septal defect……………………………………...........40 104 4.3.4 Atrioventricular septal defect………………………………………41 105 4.3.5 Coarctation of the aorta……………………………………………41 106 4.3.6 Pulmonary valve and right ventricular outflow tract disease…..41 107 4.3.7 Congenital aortic stenosis…………………………………………42 108 4.3.8 Tetralogy of Fallot…………………………………………………..42 109 4.3.9 Ebstein’s anomaly………………………………………………….42 110 4.3.10 Transposition of the great arteries………………………………43 111 4.3.11 Congenitally corrected transposition of the great arteries……43 112 4.3.12 Fontan circulation…………………………………………………44 113 4.4 Recommendations .............................................................................. 45 114 5. Aortic diseases ................................................................................................ 47 115 5.1 Maternal and offspring risk .................................................................. 47 116 5.2 Specific syndromes ............................................................................. 47 117 5.2.1 Marfan syndrome…………………………………………………….48 118 5.2.2 Bicuspid aortic valve…………………………………………………48 119 5.2.3 Vascular Ehlers–Danlos syndrome………………………………..48 120 5.2.4 Turner syndrome…………………………………………………….49

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