Specialists in Obstetric Haematology continue to be challenged by pregnant women with mechanical heart valves, who are at high risk of death or severe morbidity. Effective anticoagulation to reduce valve thrombosis inevitably increases risk of obstetric haemorrhage and fetal loss or harm, and difficult decisions need to be made. Lester and mulitdisciplinary colleagues on behalf of the British Society for Haematology review available evidence and provide comprehensive recommendations to guide management in this difficult area. Commentary on: Lester et al. British Society for Haematology guideline for anticoagulant management of pregnant individuals with mechanical heart valves. Br J Haematol 2023;202:465–478.

Congenital heart disease is the most common congenital abnormality, affecting 0.8% of births. There have been major advances in both the surgical and interventional treatment of congenital heart disease, with about 85% of patients now surviving into adulthood. Congenital heart disease can be divided into simple and complex lesions. Simple lesions include atrial septal defect, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and left ventricular outflow tract lesions. Complex lesions include tetralogy of Fallot, complete transposition of great arteries, single ventricle/Fontan physiology, pulmonary atresia, and Ebstein’s anomaly of the tricuspid valve. This chapter reviews the clinical features and management of those congenital cardiac disorders seen in adolescents and adults.

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