Valvular heart disease in pregnancy: a review of the literature.
The population of pregnant women with valvular heart disease represents a unique patient group with increased risk for adverse outcomes. The significant hemodynamic changes that occur during pregnancy can mimic symptoms of congestive heart failure. Furthermore, many patients with valvular heart disease are first recognized during pregnancy. Pre-pregnancy intervention is of utmost importance in high-risk women who present for evaluation before a planned pregnancy. This is more so if the valvular lesion is amenable for percutaneous intervention or repair, without replacement. Besides management during the antepartal period, timing and mode of delivery should be decided upon jointly by the obstetrician, cardiologist, and obstetric anesthesiologist. Prosthetic mechanical valves which require anticoagulation present a high risk subset of patients. The American Heart Association/American College of Cardiology Task Force recommends continuous therapeutic anticoagulation with frequent monitoring. Warfarin and Heparin have been recommended. Low molecular weight heparin is not recommended to be administered to pregnant patients with mechanical prosthetic valves unless anti-Xa levels are monitored 4 to 6 h after administration. Aspirin at low doses, 81-325 mg has been proposed to reduce the risk of thrombosis. At this moment, optimal antithrombotic therapy in pregnant women with mechanical valves cannot be definitively recommended due to lack of properly designed studies.
Martinez-Diaz
Jorge L
JL
Cardiology Section, Department of Medicine, VA Caribbean Healthcare System, San Juan, Puerto Rico, USA. Jorge.Martinez-Diaz@va.gov
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002404:Catheterization; D003376:Counseling; D036861:Delivery, Obstetric; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D011256:Pregnancy Outcome; D012307:Risk Factors; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D006493:Heparin; D001241:Aspirin