Pregnancy is a hyper dynamic state that is associated with severe hemodynamic changes like high cardiac output, increased blood volume, redistribution of regional blood flow and increased oxygen consumption that are well tolerated by normal women and many women with cardiac disease. But it can be challenging for some cardiac patients especially with severe and complex disease. About 287000 maternal deaths occur each year worldwide [1]. Cardiac disease is one of the important causes of maternal mortality and morbidity both in antepartum and postpartum period. Pregnancy makes a significant demand on the cardiovascular system. The circulatory changes of pregnancy in the presence of maternal heart disease may result in adverse consequences, even death of the mother or fetus[2]. About 15-52% of cardiac abnormalities are first diagnosed during routine antenatal examination or because of symptoms brought about by the physiological changes of pregnancy [