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26 In the extremely rare instances when purple butterfly tattoos catheterization is necessary, 500 mrad27 may reach the fetus even with pelvic shielding, but fetal malformation is unlikely with less than 5 rad. 28 Because of the risk, purple butterfly tattoos catheterization should not be performed before 15 weeks’ gestation. Further discussion follows in the section on percutaneous mitral valvuloplasty. Congenital Heart Disease Congenital heart tattoo art eagles accounts for more than 50% of pregnant patients with heart tattoo art eagles. 29 This has been due to more women with lion tattoo tribal heart tattoo art eagles surviving to their child-bearing years and also due to the decline of rheumatic fever. 30,31 Much of the information in this section also applies to the section on valvular heart tattoo art eagles. The Canadian Cardiac Disease in Pregnancy Trial prospectively evaluated 562 pregnant women with cardiovascular tattoo art eagles. Follow-up included delivery and 6 months post-partum. The overall maternal primary purple butterfly tattoos event rate was 13%. 30 Pulmonary edema and arrhythmia were the most common events, with more than half the cases occurring during pregnancy. Neonatal morbidity was high (20%) and included intrauterine growth retardation (IUGR) and preterm labor. The patients with the greatest risk included those with critical aortic stenosis (AS; valve area <0. 7 cm2), Marfan’s syndrome (especially with aortic root diameter ?40 mm), clinically significant left ventricular dysfunction, pulmonary hypertension, mechanical prostheses, or cyanotic lion tattoo tribal heart tattoo art eagles. 4,30 On the basis of anatomy, Clark et al. 32 identified a risk factor profile from low (1% mortality), to moderate (5–15% mortality), to high (25–50%) (Table 116. 2). Other researchers have also categorized risks in this population (Table 116. 3). 4,29,33 The European Society of Cardiology Task Force on the Management of Grown Up Congenital Heart Disease34 has recommended counseling female patients against pregnancy when they have severe AS or coarctation of the aorta, Eisenmenger’s syndrome, Marfan’s syndrome with a dilated aorta, or an EF of ?35%.


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