الفهرس 
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Abstract
Recent progress in pediatric cardiology and heart surgery has made it possible for children with congenital heart disease to survive to adulthood. Pregnancy represents a new challenge in this group of patients, whose natural history has been modified by surgery.
The number of pregnant women with coronary disease is expected to grow and even though rheumatic fever has decreased in developed countries in recent years, it continues to be a serious problem in developing countries. Especially in the area of this study.
This study was conducted at Benha University Hospital and as a part of Euro heart survey for registry of heart disease and pregnancy. The Euro Heart Survey of heart diseases and pregnancy is a large survey in Europe and the Mediterranean basin. The data derived from this survey serve as a benchmark for the relative proportion of each type of structural heart disease the current study included 50 pregnant female enrolled in the study from December 2007 to may 2009.
The data of the patients were analyzed in a non randomized manner. The study included all pregnant female presenting with structural heart disease who got pregnant with exclusion of the patients with non structural heart disease such as arrhythmia,
In our survey data was collecting using Full history taking , Thorough physical examination., Twelve lead ECG, Transthorasic Echocardiography, Lab Investigation.
According to the type of structural heart disease, there were 40 patients (80%) with valvular heart disease, 4 patients (8%) with cardiomyopathy, 4patients (8%) with congenital heart disease and 2 patients (4%) with ischemic heart disease. The majority of patients were rheumatic in nature no patients were enrolled in this study had cyanotic heart disease.
Through our study the pregnant women on anticoagulant therapy were on wafarin or wafarin +unfractionated heparin which was used in the 1st trimester and 2 weeks before labour, the follow up of these patients showed that a dose of warfarin less or equal to 5 mg is more effective in prevention of thromboembolic event and also safe to both mother and fetus
In our study there were a lot of factors that might predict maternal out come, These factors were impaired LVEF > 40%, MVA> 1.5, persistent AF , Use of anticoagulant, and other factors that might predict fetal outcome those were LVEF > 40%, mother with congenital heart disease, use of anticoagulants
Among our study group 3 patients died 2 of them during the 3rd trimester due to cardiac cause, the 1st woman was 28 years old with aortic valve prosthesis, developed thrombosis of prosthetic valve , and intractable heart failure, the 2nd woman was 29 years old with DCM, LVEF 25%, the 3rd woman died due to obstructed labour and urgent section .
We found that pregnant female with prosthetic valves, Impaired LVEF, and severe mitral stenosis, were at high risk for worsen maternal out come so Pregnancy should be avoided in this risky group, Therapeutic abortion should be done, or strict follow up during the 3rd trimester, during labour and after labour for pregnant females with high risk.
We found that pregnant females with valvuar regurgitation, non cyanotic congenital Heart disease, IHD are at low risk, they can tolerate pregnancy safely with out complications, but they need regular follow