Which of the following cardiac condition has highest maternal moality in pregnancy ?

Maternal moality associated with Eissenmenger's syndrome is 50%, and is also associated with high perinatal loss. In such cases, termination of pregnancy is indicated. Patients with Eisenmenger's syndrome have pulmonary hypeension with right to left shunt through an open ductus, ASD or VSD. Reference: Textbook of Obstetrics By D.C Dutta, 6e page 282.