Table 6

‚ÄÉRisk of combined hormonal contraceptives for different cardiac conditions

WHO 1 WHO 2WHO 3WHO 4
Always useableBroadly useableCaution in useDo not use
ASD, atrial septal defect; AVM, arteriovenous malformation; LV, left ventricular; LVEF, left ventricular ejection fraction; VSD, ventricular septal defect.
Minor valve lesions; mitral valve prolapse with trivial mitral regurgitation; bicuspid aortic valve with normal functionTissue prosthetic valve lacking any WHOs 3 or 4 featureThrombotic risk, even on warfarinMechanical valves: bileaflet valveThrombotic risk, even on warfarinMechanical valves: Starr Edwards; Bjork Shiley; any tricuspid valve
Mild pulmonary stenosis
Repaired coarctation with no hypertension or aneurysmUncomplicated mild native mitral and aortic valve diseasePrevious thromboembolismIschaemic heart disease
Simple congenital lesions successfully repaired in childhood and with no sequelaeMost arrhythmias other than atrial fibrillation or flutterAtrial arrhythmiaPulmonary hypertension any cause
Hypertrophic cardiomyopathy lacking any WHO 3 or 4 featuresDilated left atrium (>4 cm)Dilated cardiomyopathy and LV dysfunction any cause LVEF <30%
Past cardiomyopathy, fully recovered, including peripartum cardiomyopathyFontan circulation
Uncomplicated Marfan syndromePrevious arteritis involving coronary arteries, e.g. Kawasaki disease
Congenital heart disease lacking any WHO 3 or 4 features; small left to right shunt not reversible with physiological manoeuvres, e.g. small VSDRisk paradoxical embolismPotential reversal of left to right shunt: unoperated ASDRisk paradoxical embolismCyanotic heart disease; pulmonary AVM