Referral criteria

Category A	Category B	Category C
Local hospital planned care Refer to MDT for opinion if required	Consider referral to MDT for discussion and advice	Refer to MDT Consider transfer of Care
	Congenital heart disease
• Successfully repaired or device closed ASD/VSD/PDA/partial or total anomalous pulmonary venous connection with no arrhythmia or LV/RV dysfunction • Repaired AVSD with no or mild left AV valve regurgitation	• Tetralogy of Fallot • Successfully repaired or stented coarctation • AVSD with residual moderate or greater left AV valve regurgitation	• Unrepaired ASD/VSD/PDA • Systemic right ventricle • Fontan circulation • Cyanotic heart disease • Unrepaired coarctation or severe recoarctation • Other complex congenital heart disease
	Arrhythmias and channelopathies
• SVT • Successfully ablated atrial arrhythmias	• Arrhythmias that are problematic or requiring 2 or more agents • Channelopathies including Brugada syndrome, Long QT syndrome, CPVT and other ion channel diseases linked to heart rhythm disturbance	• Poorly controlled ventricular arrhythmias
	Aortic disease
	• Marfan syndrome with normal aorta • Bicuspid AV with Aorta <45 mm • Previous aortic dissection • Turner Syndrome (irrespective of aortic dimensions)	• Marfan syndrome with dilated aorta • Loeys-Dietz syndrome, Takayasu’s Disese (irrespective of aortic dimensions) • Turner’s syndrome with aortic dimensions) • Aorta >45 mm in association with bicuspid aortic valve • Vascular Ehlers-Danlos Syndrome (all patients)
	Valvular heart disease
• Mild to moderate AS/AR, MR, PS/PR with no evidence of LV/RV dysfunction • Mild mitral stenosis with no current atrial arrhythmia	• Any bioprosthetic valve • MR severe or with evidence of LV • PS/PR severe or with evidence of RV dysfunction	• Any mechanical valve • AS/AR – moderate or severe or with evidence of LV dysfunction • Mitral stenosis
	Myocardial disease
• Left ventricular impairment that is mild and stable but with a low threshold for MDT referra	• Cardiomyopathies including hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular non-compaction and other inherited disorders of heart muscle • Left ventricular impairment of any cause that is moderate • Previous or current peripartum cardiomyopathy (including if LV function normal after previous peripartum cardiomyopathy)	• Left ventricular impairment of any cause that is moderate-severe or severe • Cardiomyopathies with significant adverse features e.g. severe LVOT obstruction with HCM, poor RV function or ventricular arrhythmia with ARVC
	Coronary disease
	• Previous myocardial infarction related to acquired coronary disease (NSTEMI or STEMI) • Previous myocardial infarction related to spontaneous coronary artery dissection • Previous myocardial infarction related to thrombotic coronary artery occlusion (paradoxical embolus, thrombus in situ)
	Pace makers and defibrillators
• Normally functioning devices with sufficient battery longevity to complete pregnancy	• Active device complications including lead malfunction, system infection, insufficient battery longevity to complete pregnancy • Appropriate and inappropriate therapy for ventricular tachycardia	• Device related complications that require tertiary cardiology care
	Other
		• Pulmonary Hypertension • Heart Transplant

Aidan Bolger
Cardiologist
UHL

Suzanne Wallace
Obstetrician
NUH

	Cardiologist	Obstetrician	Midwife	Specialist Nurse	Anaesthetist
UHL	Aidan Bolger	Manjiri Khare	Zoe Barratt	Emma Sparks	Prea Ramasamy
NUH	Mike Sosin Bara Eryahiem Tim Robinson	Suzanne Wallace Lucy Kean			Amelia Banks
UHDB		Sasha Rajendran
CRH
SFH	Asif Khan	Jyothi Rajeswary
ULH		Kavita Agarwal Charalampos Stamatopoulos
NGH	Hanish Sall Liz Orchard	Amrita Datta
KGH		Mohamed Osman		Jeremy Stone