Valvular heart disease and pregnancy

Abstract

The population of women with valvular disease who are of childbearing age continues to increase. Many will want to become pregnant or may present already pregnant, and in some cases, underlying valve disease will complicate pregnancy, increasing the risk for adverse outcomes for the mother and fetus. This chapter discusses the hemodynamic changes of pregnancy and the implications for patients with valve disease. Focus is on the physiology and outcomes of pregnancy with specific valve lesions. There is a discussion of particular issues that may be relevant in these patients, such as anticoagulation for mechanical valves and cardiac surgery during pregnancy. Issues to be addressed during labor and delivery are described. Ideally, women with valvular disease will present prior to pregnancy, allowing for preconceptual counseling. Thus, strategies to assess risk include currently available risk scores that can aid in counseling, regardless of specific valve abnormality.