The number of pregnancy with congenital heart disease has been increasing recently along with drastically increased population of adult congenital heart disease (ACHD) patients all over the world. We have the longest history of ACHD services in Japan so that the biggest volume of ACHD patients and their pregnancies. The management of pregnant ACHD patients faces new challenges and experiences from time to time because they are truly “New Population” especially when they have complex congenital heart disease with/without complex cardiac surgeries. It is necessary for the safe and sufficient medical care before and after pregnancy that we understand haemodynamics and problems in long term after various operations such as Senning, Mustard, Rastelli, Fontan, even double switch operation, or ventricular septation. In addition to the repaired Tetralogy of Fallot, those complicated post-operative settings should be assessed clearly before pregnancy in order to predict the changes caused by pregnancy. Since pregnancy and pregnant ACHD patients are moving target, it is very important to notice the early signs for providing the right care during pregnancy. A good guide and advice to the pregnant ACHD patients at any moment contributes not only to the better course throughout pregnancy and delivery but also to the life-long cardiac history of female ACHD patients.
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