Risk Score of Drenthen et al for Cardiac Complications in a Woman with Congenital Heart Disease Who Completes a Pregnancy (ZAHARA Score)

Patient selection: women with congenital heart disease and a completed pregnancy (defined as > 20 weeks of gestation)

Outcome: cardiac complications (arrhythmias, heart failure, myocardial infarction, stroke, thromboemboli, endocarditis)

Parameters:

(1) history of arrhythmias

(2) therapy with a cardiac medication prior to the pregnancy

(3) NYHA class prior to pregnancy

(4) left heart obstruction (LHO)

(5) systemic atrioventricular (AV) valve regurgitation

(6) pulmonary AV valve regurgitation

(7) mechanical valve prosthesis

(8) cyanotic heart disease (corrected or uncorrected)

where:

• LHO was defined as aortic valve area < 1 square cm or peak gradient (PG) > 50 mm Hg.

• Systemic AV valve regurgitation may refer to the mitral valve.

• Pulmonary AV valve regurgitation may refer to the tricuspid valve.

total score =

= SUM(points for all 8 parameters)

Interpretation:

• minimum score: 0

• maximum score: 13

• The higher the score the greater the risk for cardiac complications.

where:

• Figure 1 reports continuous ranges, but only a limited number of combinations are possible.