Management of pregnant women with prosthetic heart valves

INTRODUCTION

Pregnancy presents a unique set of problems for women with prosthetic heart valves. Mechanical heart valves are associated with an increased incidence of thromboembolic events during pregnancy. Anticoagulation with oral anticoagulants, usually warfarin, provides protection against these complications, but its use increases the risk of embryopathy and stillbirth.

Bioprosthetic valves typically do not require anticoagulation (unless there are other thromboembolic risk factors), but bioprostheses have a significantly higher incidence of valve failure than mechanical valves. This may be of particular concern for young women, who must consider the potential for future valve surgery if they have a bioprosthesis. (See "Management of patients with prosthetic heart valves".)

There is a lack of agreement as to the optimal treatment of pregnant women with prosthetic heart valves, due to the absence of adequate prospective controlled trials [1-3]. The available data regarding the risk of prosthetic valves in pregnancy (particularly thromboembolic disease), the risks of anticoagulation, and the efficacy of anticoagulation during pregnancy will be reviewed here.

Management of pregnancy women with prosthetic heart valves, including anticoagulant therapy is discussed here. Antimicrobial prophylaxis in patients with prosthetic heart valves is discussed separately. (See "Antimicrobial prophylaxis for bacterial endocarditis".)

RISKS OF PROSTHETIC VALVES

Prosthetic heart valves are associated with a variety of complications, including thromboembolism, structural failure, bleeding due to anticoagulation, and infection. The overall incidence of complications in appropriately managed, nonpregnant patients with prosthetic valves is approximately 3 percent per year. (See "Complications of prosthetic heart valves".)
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