Table 34. Pregnancy and VHD
Recommendations COR LOE
Native Valve Stenosis
All patients with suspected valve stenosis should undergo a
clinical evaluation and TTE before pregnancy.
I C
All patients with severe valve stenosis (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
about the risks and benefits of all options for operative
interventions, including mechanical prosthesis, bioprosthesis,
and valve repair.
I C
Pregnant patients with severe valve stenosis (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 the management of high-
risk cardiac patients during pregnancy.
I C
Exercise testing is reasonable in asymptomatic patients
with severe AS (aortic velocity ≥4.0 m/s or
ΔPmean ≥40 mm Hg, stage C) before pregnancy.
IIa C
Medical erapy
Anticoagulation should be given to pregnant patients with
MS and AF unless contraindicated.
I C
Use of beta blockers as required for rate control is
reasonable for pregnant patients with MS in the absence
of contraindication if tolerated.
IIa C
Use of diuretics may be reasonable for pregnant patients with
MS and HF symptoms (stage D).
IIb C
ACE inhibitors and ARBs should NOT be given to pregnant
patients with valve stenosis.
III: Harm B
Intervention
Valve intervention is recommended before pregnancy for
symptomatic patients with severe AS (aortic velocity ≥4.0 m/s
or ΔPmean ≥40 mm Hg, stage D).
I C
Valve intervention is recommended before pregnancy for
symptomatic patients with severe MS (MVA ≤1.5 cm
2
, stage D).
I C
PMBC is recommended before pregnancy for asymptomatic
patients with severe MS (MVA ≤1.5 cm
2
, stage C)
who have valve morphology favorable for PMBC.
I C
Valve intervention is reasonable before pregnancy for
asymptomatic patients with severe AS (aortic velocity
≥4.0 m/s or ΔPmean ≥40 mm Hg, stage C).
IIa C
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