Management of valvular disease in pregnancy: a global perspective.
Valvular heart disease (VHD) in pregnant women, whether due to congenital or acquired aetiologies, poses a challenge to clinicians and their patients. Significant valve disease, which can affect a single valve or several valves, increases the risk of pregnancy to the mother and foetus and requires a careful preconception risk assessment and, subsequently during pregnancy, specialized care to minimize maternal and foetal morbidity and mortality. The goal of this paper is to provide a guide to risk assessment and to give an overview of the optimal cardiac and obstetric management, including surgical intervention, taking into consideration the resources available in higher and lower-to-middle income countries. This manuscript provides a practical approach and is not replacing comprehensive guidelines on the management of VHD or cardiovascular disease in pregnancy. It focuses on common valvular diseases and does not cover the large variety of aortic disease with and without valve disease or complex congenital heart disease in detail.
Hatter Institute for Cardiovascular Research in Africa & IDM, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa Inter-Cape Heart Group, Medical Research Council, South Africa karen.sliwa-hahnle@uct.ac.za.
Karen
K
Sliwa
Chelsea and Westminster Imperial College Hospital, London, UK.
Mark R
MR
Johnson
Inter-Cape Heart Group, Medical Research Council, South Africa Chris Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Peter
P
Zilla
Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
Jolien W
JW
Roos-Hesselink
D063126:Balloon Valvuloplasty / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy; D006349:Heart Valve Diseases / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D011295:Prenatal Care / Q000379:methods*; D011296:Prenatal Diagnosis / Q000379:methods; D011474:Prosthesis Design; D012214:Rheumatic Heart Disease / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods
Rheumatic heart disease in pregnancy; Valve disease; Valve thrombosis