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Pregnancy in Repaired Tetralogy of Fallot — EECC MCQ

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ModerateCongenital Heart Disease (Adult)Pregnancy in Repaired Tetralogy of FallotEECC

A 32-year-old woman with repaired tetralogy of Fallot wishes to become pregnant. Her echocardiography shows severe pulmonary regurgitation, mildly dilated RV with preserved function (RVEF 48% on CMR), and LVEF 58%. She is in NYHA class I. According to the 2025 ESC CVD in Pregnancy Guidelines, what is her modified WHO (mWHO) pregnancy risk classification?

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Correct answer: D — mWHO class II-III: moderate-to-high risk requiring specialist cardiac and obstetric care during pregnancy

Repaired tetralogy of Fallot with good ventricular function is typically classified as mWHO class II-III in the 2025 ESC CVD in Pregnancy Guidelines. The severe PR and RV dilatation increase haemodynamic risk during pregnancy (30-50% increase in blood volume). Pregnancy is generally tolerated if RV function is preserved, but requires specialist cardiac and obstetric monitoring with echocardiographic surveillance. If RV function is significantly impaired (RVEF <40%), the risk increases to mWHO III-IV. Pulmonary valve replacement before pregnancy may be considered if there is significant RV dilatation to optimise haemodynamic tolerance.

Reference: ESC (2025): Guidelines for CVD in Pregnancy; ESC (2020): ACHD Guidelines