Catheter-Based Interventions for the Management of Valvular Heart Disease During Pregnancy

Cardio-Obstetrics Team-Based Management of a Pregnant Patient With Severe Bioprosthetic Aortic Valve Disease

“…To date, valve-in-valve TAVR for bioprosthetic degeneration in pregnancy has been completed in a few cases and limited outcome information is available, but there appears to be short-term safety and efficacy of this intervention. 7 …”

Treatment of Severe Symptomatic Aortic Stenosis During Pregnancy

“…If a patient has symptomatic severe AS, severe AS with left ventricular dysfunction, or an abnormal exercise stress test result, they should be referred for SAVR before pregnancy. 3 Guidelines differ in the recommendation for preconception intervention in patients with asymptomatic severe AS. The European Society of Cardiology guidelines recommend intervention if the AS is very severe with mean gradient of ≥60 mm Hg or peak velocity of ≥5 m/s or markedly elevated BNP in the absence of symptoms.…”

“…The 2020 American College of Cardiology and American Heart Association guidelines recommend intervention in patients with severe AS who are contemplating pregnancy in the absence of symptoms. 3 …”

“…Hemodynamic measurement in the catheterization laboratory can be valuable if there is uncertainty regarding the severity of AS. 3 If a patient develops symptoms attributable to AS, management with exercise restriction and diuretics should be attempted. In patients with refractory symptoms, valvular intervention should be considered.…”

“…Although there are no large case series of BAV during pregnancy, case reports have shown favorable results with no maternal or fetal death. 3 SAVR is associated with a high rate of prematurity (∼50%) and fetal loss (∼15%-25%). 6 , 7 Experience with TAVR during pregnancy is limited.…”