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2017 Update Incorporated - Valvular Heart Disease

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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

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