Page 163 - Clinical Pearls in Cardiology

Congenital Heart Disease 151

vena cava via the ductus venosus. This oxygenated
blood reaches the right atrium via the inferior vena cava.
Then this blood streams from the right atrium through
the open foramen ovale into the left atrium and via the
left ventricle into the ascending aorta. This oxygen-rich
blood then enters the major head and neck vessels and
goes to supply the organs in the upper part of the body
which require more oxygen like the brain.
The venous blood returning from the head and neck
region reaches the right atrium via the superior vena
cava and then partly mixes with the oxygenated blood
in the right atrium. Then it passes into the right ventricle
and goes to the pulmonary artery. The pulmonary
vasculature has high vascular resistance and so very
little of this blood passes into the lungs. Most of this less
oxygenated blood passes through the ductus arteriosus
into the descending aorta and goes to supply the organs
in the lower part of the body which require less oxygen
like the kidneys and the intestinal tract. This blood then
returns to the placenta via the two umbilical arteries.
19. Which are the cardiac conditions where pregnancy is
strictly contraindicated?
Mother’s health is at risk and pregnancy is strictly
contraindicated if she has any one of the following
cardiac problems:
• Pulmonary hypertension—as in Eisenmenger’s
syndrome or advanced severe mitral stenosis
• Left ventricular outflow tract obstruction—as in aortic
stenosis
• Dilated cardiomyopathy with congestive failure
• Cyanotic congenital heart disease