55
Table 37. Pregnancy and VHD (cont'd)
Recommendations
COR LOE
Intervention
Valve repair or replacement is recommended before pregnancy
for symptomatic women with severe valve regurgitation
(stage D).
I C
Valve operation for pregnant patients with severe valve
regurgitation is reasonable only if there are refractory NYHA
class IV HF symptoms (stage D).
IIa C
Valve repair before pregnancy may be considered in the
asymptomatic patient with severe MR (stage C) and a valve
suitable for repair, but only aer detailed discussion with the
patient about the risks and benefits of the operation and its
outcome on future pregnancies.
IIb C
Valve operations should NOT be performed in pregnant
patients with valve regurgitation in the absence of severe
intractable HF symptoms.
III:Harm C
Prosthetic Valves
All patients with a prosthetic valve should undergo a clinical
evaluation and baseline TTE before pregnancy.
I C
All patients with a prosthetic valve should undergo
prepregnancy counseling by a cardiologist with expertise
in managing patients with VHD during pregnancy.
I C
TTE should be performed in all pregnant patients with a
prosthetic valve if not done before pregnancy.
I C
Repeat TTE should be performed in all pregnant patients
with a prosthetic valve who develop symptoms.
I C
TEE should be performed in all pregnant patients with
a mechanical prosthetic valve who have prosthetic valve
obstruction or experience an embolic event.
I C
Pregnant patients with a mechanical prosthesis should be
monitored in a tertiary care center with a dedicated Heart
Valve Team of cardiologists, surgeons, anesthesiologists, and
obstetricians with expertise in the management of high-risk
cardiac patients.
I C
