title: Maternal valvular heart disease in pregnancy.
abstract: Valvular heart disease is common in pregnancy. Maternal physiology changes significantly during gestation with substantial increases in cardiac output and blood volume; this can cause unmasking or worsening of cardiac disease. Acquired valvular lesions most frequently arise from rheumatic fever, especially in patients who have emigrated from developing nations. Congenital lesions are also encountered. The most common conditions seen, mitral stenosis and regurgitation and aortic stenosis and regurgitation, each require a specific evaluation and management and are associated with their own set of possible complications. Patients with prosthetic valves require anticoagulation, and maternal and fetal risks and benefits must be carefully weighed. Patients with heart disease should be meticulously managed preconceptionally up to the postpartum period by maternal-fetal medicine specialists, obstetricians, cardiologists, and anesthesiologists using a multi-disciplinary approach to their cardiac conditions.
  
  
  BACKGROUND
  Obstetricians & Gynecologists and Family Physicians.
  
  
  OBJECTIVE
  After the completing the CME activity, physicians should be better able to examine the epidemiology of valvular heart disease in pregnancy, categorize key physiologic parameters that change in the cardiovascular system during pregnancy, classify the pathophysiology of valvular lesions, and evaluate the general principles of maternal and fetal management for cardiac disease.
authors.affiliation: Department of Reproductive Medicine, Division of Perinatology, University of California San Diego, San Diego, CA 92103, USA. haroeder@ucsd.edu
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Roeder
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kuller
authors.forename: Piers C A
authors.initials: PC
authors.lastname: Barker
authors.forename: Andra H
authors.initials: AH
authors.lastname: James
mesh_terms: D002320:Cardiovascular Physiological Phenomena; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000033:anatomy & histology / Q000502:physiology; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012214:Rheumatic Heart Disease / Q000150:complications