Native Valve Regurgitation in Pregnancy

Valvular Heart Disease in Pregnancy Microchapters
Cardiac disease in pregnancy
2014 AHA/ACC guideline for the management of patients with valvular heart disease
Native Valve Stenosis in Pregnancy
Native Valve Regurgitation in Pregnancy
Prosthetic Valves in Pregnancy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Native Valve Regurgitation in Pregnancy

Diagnosis and Follow-up

Class I

"1. All patients with suspected valve regurgitation should undergo a clinical evaluation and TTE before pregnancy.(Level of Evidence: C)"

"2. All patients with severe valve regurgitation (stages C and D) should undergo prepregnancy counseling by a cardiologist with expertise in managing patients with VHD during pregnancy.(Level of Evidence: C)"

"3. All patients referred for a valve operation before pregnancy should receive prepregnancy counseling by a cardiologist with expertise in managing patients with VHD during pregnancy regarding the risks and benefits of all options for operative interventions, including mechanical prosthesis, bioprosthesis, and valve repair.(Level of Evidence: C)"

"4. Pregnant patients with severe regurgitation (stages C and D) should be monitored in a tertiary care center with a dedicated Heart Valve Team of cardiologists, surgeons, anesthesiologists, and obstetricians with expertise in managing high-risk cardiac patients.(Level of Evidence: C)"

Class IIa

"1. Exercise testing is reasonable in asymptomatic patients with severe valve regurgitation (stage C) before pregnancy.(Level of Evidence: C)"

Medical Therapy

Class III (Harm)

"1. ACE inhibitors and ARBs should not be given to pregnant patients with valve regurgitation (Level of Evidence: B)"

Intervention

Class I

"1. Valve repair or replacement is recommended before pregnancy for symptomatic women with severe valve regurgitation (stage D).(Level of Evidence: C)"

Class IIa

"1. Valve operation for pregnant patients with severe valve regurgitation is reasonable only if there are refractory NYHA class IV HF symptoms (stage D). (Level of Evidence: C)"

Class IIb

"1. Valve repair before pregnancy may be considered in the asymptomatic patient with severe MR (stage C) and a valve suitable for valve repair, but only after detailed discussion with the patient about the risks and benefits of the operation and its outcome on future pregnancies. (Level of Evidence: C)"

Class III (Harm)

"1. Valve operations should not be performed in pregnant patients with valve regurgitation in the absence of severe intractable HF symptoms. (Level of Evidence: C)"