54
Pregnancy and VHD
Table 37. Pregnancy and VHD (cont'd)
Recommendations
COR LOE
Intervention (cont'd)
PMBC is reasonable for pregnant patients with severe MS
(MVA ≤1.5 cm
2
, stage D) with valve morpholog y favorable
for PMBC who remain symptomatic with NYHA class III-IV
HF symptoms despite medical therapy.
IIa B
Valve intervention is reasonable for pregnant patients with
severe MS (MVA ≤1.5 cm
2
, stage D) and valve morpholog y
not favorable for PMBC only if there are refractory NYHA
class IV HF symptoms.
IIa C
Valve intervention is reasonable for pregnant patients with
severe AS (ΔPmean ≥40 mm Hg, stage D) only if there is
hemodynamic deterioration or NYHA class III-IV HF
symptoms.
IIa B
Valve operation should NOT be performed in pregnant
patients with valve stenosis in the absence of severe HF
symptoms.
III:Harm C
Native Valve Regurgitation
All patients with suspected valve regurgitation should
undergo a clinical evaluation and TTE before pregnancy.
I C
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.
I C
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.
I C
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.
I C
Exercise testing is reasonable in asymptomatic patients with
severe valve regurgitation (stage C) before pregnancy.
IIa C
ACE inhibitors and AR Bs should NOT be given to pregnant
patients with valve regurgitation.
III: Harm B
