Cardiac disease in pregnancy and valvular heart disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Anjan K. Chakrabarti, M.D. [2]
Overview
As previously mentioned, rheumatic heart disease remains prevalent in developing countries but is less common in Western countries; as a result Western countries see less mitral stenosis complicating pregnancy. Bicuspid aortic stenosis, mitral regurgitation, aortic regurgitation, and prosthetic valves can all be problematic during pregnancy due to physiologic hemodynamic changes.
For a general overview of valvular heart disease, click here.
Specific Issues with Valvular Disease in Pregnancy
Mitral Stenosis
- Increase in cardiac output coupled with the increase in heart rate shortens the diastolic filling time
- Tends to exaggerate the mitral valve gradient
- Patients should have echocardiography prior to proceeding with pregnancy
- Exercise echocardiography may be warranted
- Judicious use of diuretics and beta-blockade are appropriate in symptomatic cases
- Balloon valvuloplasty has been described in symptomatic cases[1]
Mitral Regurgitation
- Fairly well tolerated in pregnancy
- The left ventricle tends to dilate as pregnancy progresses, and this may worsen mitral regurgitation
- Early delivery is sometimes necessary in case of maternal hemodynamic instability
Aortic Insufficiency
- As with mitral regurgitation, fairly well tolerated
- Closer monitoring is warranted, early delivery may be necessary
Aortic Stenosis
- Generally due to bicuspid aortic valve
- Moderate stenosis may be tolerated in a compliant patient who is monitored closely
- Aortic root dilation > 4.5cm is a contraindication to pregnancy.
- Balloon valvuloplasty has been safely performed in a small subset of pregnancy patients with some success, as described by Myerson et al.[2]
Prosthetic Valves and Pregnancy[3]
References
- ↑ Routray SN, Mishra TK, Swain S, Patnaik UK, Behera M (2004). "Balloon mitral valvuloplasty during pregnancy". Int J Gynaecol Obstet. 85 (1): 18–23. doi:10.1016/j.ijgo.2003.09.005. PMID 15050462.
- ↑ Myerson SG, Mitchell AR, Ormerod OJ, Banning AP (2005). "What is the role of balloon dilatation for severe aortic stenosis during pregnancy?". J Heart Valve Dis. 14 (2): 147–50. PMID 15792172.
- ↑ Elkayam U, Singh H, Irani A, Akhter MW (2004). "Anticoagulation in pregnant women with prosthetic heart valves". J Cardiovasc Pharmacol Ther. 9 (2): 107–15. PMID 15309247.