Pregnancy and aortic valve regurgitation

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Pregnancy and aortic valve regurgitation

Women with aortic valve regurgitation who want to have children have some special considerations because the condition—with or without symptoms—can increase maternal and fetal risk.

If possible, you should try to have valve replacement surgery before you conceive. However, many pregnant women with aortic valve regurgitation have successful pregnancies; this requires careful medical attention using a combination of medications that flush excess fluids out of their system (diuretics) and medications to relax and expand the blood vessels (vasodilators). Even simple treatments, such as plenty of bed rest and avoiding lying flat, can play an important role in a safe pregnancy.

You are at higher risk for complications with pregnancy if you have a marked limitation on physical activity or are unable to carry on any physical activity without discomfort (New York Heart Association heart failure functional class III to class IV) or if your regurgitation is caused by Marfan's syndrome, a disorder of the body's connective tissue.¹ If you have NYHA class III or IV symptoms, it may be necessary to perform valve replacement surgery while you are pregnant.¹

If you are considering pregnancy and you have aortic valve regurgitation, you should gather more advice from a multidisciplinary medical team that can provide more information about your individual risk factors and long-term outcome.

If you plan to or may become pregnant after heart valve replacement, you need to consider the following:

• Your aortic valve can be replaced with either a mechanical or biological valve.
• Anticoagulants, also called blood-thinning medications, may be necessary after valve replacement surgery to prevent blood clots. Anticoagulants are needed over the long term if the replacement valve is mechanical.
• If you choose a mechanical valve, you should avoid using the anticoagulant warfarin (such as Coumadin) because it can cause birth defects. Work with your doctor to choose an anticoagulant (such as heparin) that is safe for you to use during pregnancy.
• Anticoagulants are not needed long-term with biological replacement valves. However, biological valves do not last as long as mechanical valves; they last about 10 to 15 years.

References

Citations

1. Bonow RO, et al. (2006) 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 Management of Patients with Valvular Heart Disease). Circulation, 114(5): e84–e231.

Credits

Last updated:	January 24, 2008
Author:	Robin Parks, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC