Cardiovascular disease has been estimated to be present in 0.1 -4% of pregnancies. (1) The incidence of pregnancies in women with heart disease is rising, mainly due to an increased number of women with congenital heart disease (CHD) Reaching childbearing age, advancing maternal age, and increased incidence of risk factors including; diabetes mellitus, hypertension, preeclampsia, and multifetal pregnancies. Although the majority of women with cardiac disease can become pregnant and, with early diagnosis and appropriate management, can be brought to term safely, they are high risk cardiac conditions that may be associated with important morbidity and even mortality. (2) Although pregnancies complicated by heart disease are rare in the UK, Europe and developed world, cardiac disease is now the leading cause of maternal death in the UK (CEMACH). (3) GIVING a death rale of 2.2 per 100,000 maternities. The maternal mortality rate from cardiac disease has continued to rise since 1980, the major causes of cardiac death are cardiomyopathy, myocardial infarction (coronary artery disease), dissection of aorta, and pulmonary hypertension .in the UK rheumatic heart disease is extremely rare in women of childbearing age and mostly confined to immigrants. They have been no maternal deaths reported from rheumatic heart disease since 1994, so heart diseases during pregnancy are the leading indirect cause of maternal death worldwide (4).