Pregnancy is contraindicated in which of the following cardiovascular condition?

World Health Organization (WHO) Risk Classification of Cardiovascular Disease and Pregnancy with Management RecommendationsWHO 1--Risk no higher than general population Uncomplicated, small, or mild: Pulmonary stenosis Ventricular septal defect Patent ductus aeriosus Mitral valve prolapse with no more than tril mitral regurgitation Successfully repaired simple lesions: Ostium Secundum atrial septal defect Ventricular septal defect Patent ductus aeriosus Total anomalous pulmonary venous drainage Isolated ventricular extrasystoles and atrial ectopic beatsWHO 2--Small increase in risk of maternal moality and morbidity If otherwise uncomplicated:Unoperated atrial septal defectRepaired Fallot tetralogyMost arrhythmiasWHO 2 or 3--Depends on individual case Mild left ventricular impairment Hyperophic cardiomyopathy Native or tissue valvular hea disease not considered WHO 4 Marfan syndrome without aoic dilation Hea transplantationWHO 3--Significantly increased risk of maternal moality or expe cardiac and obstetrical care requiredMechanical valveSystemic right ventricle--congenitally corrected transposition, simple transposition post Mustard or Senning repairPost-Fontan operationCyanotic hea diseaseOther complex congenital hea diseasesWHO 4--Very high risk of maternal moality or severe morbidity; pregnancy contraindicated and termination discussedPulmonary aerial hypeensionSevere systemic ventricular dysfunction (NYHA III-IV or LVEF <30%)Previous peripaum cardiomyopathy with any residual impairment of left ventricular functionSevere left hea obstructionMarfan syndrome with aoa dilated >40 mmReference: William's obstetrics; 25th edition; Chapter 49; Cardiovascular Disorders