A 28-year-old with known bicuspid aortic valve (regurgitation, mild) and normal LV function becomes pregnant. She is in NYHA class I. According to the modified WHO (mWHO) cardiac risk classification for pregnancy, she falls in which class?

• A mWHO Class II — slightly increased risk, usually well tolerated ✓
• B mWHO Class I — no detectable increased risk of maternal mortality
• C mWHO Class II-III — moderately increased risk requiring specialist review
• D mWHO Class III — significantly increased risk, requires expert cardio-obstetric team

Explanation

The modified WHO cardiac risk classification (ESC 2018 guidelines) places most non-complex valvular lesions with normal ventricular function in mWHO Class II (small increased risk of maternal mortality; complications possible but manageable with expert input). Mild to moderate left-sided regurgitant lesions with preserved LV function in NYHA class I are typically mWHO II. Severe aortic stenosis or significant aortic dilatation (>45 mm) with bicuspid AV would be mWHO III or IV. mWHO Class I includes repaired simple lesions (small VSD, successfully repaired PDA, pulmonary/tricuspid disease with good function). Expert cardio-obstetric review is still recommended for all mWHO II patients.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.