Valvular heart disease in pregnancy: A review

Pregnancy is associated with significant hemodynamic changes that can aggravate valvular heart disease and increase the risk of thrombo-embolic events. Risk during pregnancy is dependent on the valve lesion, its severity, maternal pre-pregnancy functional capacity and the degree of left ventricular systolic function. For stenotic lesions, maternal and fetal risk increases when mitral or aortic valve area is less than 1.5 cm2. Pregnancy is usually well tolerated in women with chronic left sided valve regurgitation without left ventricular dysfunction. In patients with heart valve prostheses, hemodynamic tolerance is generally good, the issue is with anticoagulation. Many women with valvular heart disease can be successfully managed throughout pregnancy, labor and delivery with conservative medical measures designed to optimize intravascular volume, systemic loading conditions, blood pressure and rhythm. High risk patients require multidisciplinary close follow-up, so that any deterioration in symptom can be detected early and managed in a timely way.