4 Cardiovascular Disorders in Pregnancy: Diagnosis and Management Mechthild Westhoff-Bleck, MD a , Edith Podewski, MD a , Andres Hilfiker, PhD b , Denise Hilfiker-Kleiner, PhD a, * a Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany b Department of Cardiothoracic, Transplantation and Vascular Surgery, Medical School Hannover, Hannover, Germany Keywords: peri-partum cardiomyopathy valvular disease Marfan’s syndrome heart failure hormones Cardiovascular diseases (CVDs) are a major cause of complications in pregnancy worldwide and the number of patients who develop cardiac problems during pregnancy is increasing. This review summarises recent literature on the aetiology and the underlying pathophysiology, diagnostic tools, risk stratification and prognosis in women who develop heart failure during pregnancy and in the peri-partum phase as well as in patients with pre-existing car- diomyopathies undergoing pregnancy. We specifically highlight peri-partum cardiomyopathy, valvular disease and Marfan’s syn- drome. Furthermore, we provide overviews on established treat- ment concepts and novel therapeutic strategies for these different disease types, stressing the point that pregnancy-associated car- diac disease requires interdisciplinary concepts for diagnosis, management and treatment. Ó 2013 Elsevier Ltd. All rights reserved. Introduction At present, 0.2–4% of all pregnancies in Western industrialised countries are complicated by car- diovascular diseases (CVDs) and the number of the patients who develop cardiac problems during pregnancy is increasing [1]. In the first part of this chapter, we focus on heart failure in previously healthy women during pregnancy and the peri-partum phase. In the second part, we summarise the current knowledge on pre-existing cardiomyopathies, specifically valvular disease and Marfan’s syn- drome in women undergoing pregnancy. * Corresponding author. Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany. Tel.: þ49 511 532 2531; Fax: þ49 511 532 3263. E-mail address: hilfiker.denise@mh-hannover.de (D. Hilfiker-Kleiner). Contents lists available at ScienceDirect Best Practice & Research Clinical Obstetrics and Gynaecology journal homepage: www.elsevier.com/locate/bpobgyn 1521-6934/$ – see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bpobgyn.2013.07.001 Best Practice & Research Clinical Obstetrics and Gynaecology 27 (2013) 821–834