Pregnancy in Women with Prosthetic Heart Valves

Overview

Journal Neth Heart J

Specialty Cardiology & Vascular Diseases

Date 2009 Jan 8

PMID 19127317

Citations 15

Authors

P G Pieper

A Balci

A P van Dijk

Affiliations

Soon will be listed here.

Abstract

Pregnancy in women with mechanical valve prostheses has a high maternal complication rate including valve thrombosis and death. Coumarin derivatives are relatively safe for the mother with a lower incidence of valve thrombosis than un-fractionated and low-molecular-weight heparin, but carry the risk of embryopathy, which is probably dose-dependent. The different anticoagulation regimens are discussed in this review. When valve thrombosis occurs during pregnancy, thrombolysis is the preferable therapeutic option. Bioprostheses have a more favourable pregnancy outcome than mechanical prostheses but due to the high re-operation rate in young women they do not constitute the ideal alternative. When women with native valve stenosis need pre-pregnancy intervention, mitral balloon valvuloplasty is the best option in mitral stenosis, while the Ross operation or homograft implantation may be the preferable surgical regimen in aortic stenosis. (Neth Heart J 2008;16:406-11.).

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References

Meschengieser S, Fondevila C, Santarelli M, Lazzari M . Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart. 1999; 82(1):23-6. PMC: 1729094. DOI: 10.1136/hrt.82.1.23. View

Bonow R, Carabello B, Chatterjee K, de Leon Jr A, Faxon D, Freed M . ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the.... J Am Coll Cardiol. 2006; 48(3):e1-148. DOI: 10.1016/j.jacc.2006.05.021. View

Silversides C, Colman J, Sermer M, Siu S . Cardiac risk in pregnant women with rheumatic mitral stenosis. Am J Cardiol. 2003; 91(11):1382-5. DOI: 10.1016/s0002-9149(03)00339-4. View

Vitale N, De Feo M, De Santo L, Pollice A, Tedesco N, Cotrufo M . Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol. 1999; 33(6):1637-41. DOI: 10.1016/s0735-1097(99)00044-3. View

Pirani B, Campbell D, MacGillivray I . Plasma volume in normal first pregnancy. J Obstet Gynaecol Br Commonw. 1973; 80(10):884-7. DOI: 10.1111/j.1471-0528.1973.tb02146.x. View

Belford P, Davis J, Wells G . A case of prosthesis-patient mismatch complicating pregnancy. Am J Perinatol. 2007; 24(4):241-2. DOI: 10.1055/s-2007-976549. View

Siu S, Sermer M, Colman J, Alvarez A, Mercier L, Morton B . Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001; 104(5):515-21. DOI: 10.1161/hc3001.093437. View

Hameed A, Karaalp I, Tummala P, Wani O, Canetti M, Akhter M . The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001; 37(3):893-9. DOI: 10.1016/s0735-1097(00)01198-0. View

Elkayam U, Bitar F . Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005; 46(2):223-30. DOI: 10.1016/j.jacc.2005.02.085. View

10.

Sahnoun-Trabelsi I, Jimenez M, Choussat A, Roudaut R . [Prosthetic valve thrombosis in pregnancy. A single-center study of 12 cases]. Arch Mal Coeur Vaiss. 2004; 97(4):305-10. View

11.

Elkayam U, Singh H, Irani A, Akhter M . Anticoagulation in pregnant women with prosthetic heart valves. J Cardiovasc Pharmacol Ther. 2004; 9(2):107-15. DOI: 10.1177/107424840400900206. View

12.

Davison J . Kidney function in pregnant women. Am J Kidney Dis. 1987; 9(4):248-52. DOI: 10.1016/s0272-6386(87)80117-8. View

13.

Sadler L, McCowan L, White H, Stewart A, Bracken M, North R . Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves. BJOG. 2000; 107(2):245-53. DOI: 10.1111/j.1471-0528.2000.tb11696.x. View

14.

Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G . Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007; 28(2):230-68. DOI: 10.1093/eurheartj/ehl428. View

15.

Lund O, Chandrasekaran V, Grocott-Mason R, Elwidaa H, Mazhar R, Khaghani A . Primary aortic valve replacement with allografts over twenty-five years: valve-related and procedure-related determinants of outcome. J Thorac Cardiovasc Surg. 1998; 117(1):77-90; discussion 90-1. DOI: 10.1016/s0022-5223(99)70471-x. View

16.

North R, Sadler L, Stewart A, McCowan L, Kerr A, White H . Long-term survival and valve-related complications in young women with cardiac valve replacements. Circulation. 1999; 99(20):2669-76. DOI: 10.1161/01.cir.99.20.2669. View

17.

Lengyel M . Thrombolysis should be regarded as first-line therapy for prosthetic valve thrombosis in the absence of contraindications. J Am Coll Cardiol. 2005; 45(2):325. DOI: 10.1016/j.jacc.2004.10.028. View

18.

Parry A, Westaby S . Cardiopulmonary bypass during pregnancy. Ann Thorac Surg. 1996; 61(6):1865-9. DOI: 10.1016/0003-4975(96)00150-6. View

19.

Turpie A, Gent M, Laupacis A, Latour Y, Gunstensen J, Basile F . A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med. 1993; 329(8):524-9. DOI: 10.1056/NEJM199308193290802. View

20.

Dore A, Somerville J . Pregnancy in patients with pulmonary autograft valve replacement. Eur Heart J. 1997; 18(10):1659-62. DOI: 10.1093/oxfordjournals.eurheartj.a015148. View