Pregnancy in patients after valve replacement.

Abstract

This report is based on information obtainedfrom a questionnaire sent to major cardiac centres in the United Kingdom. This produced details of 39 pregnancies in 34 patients after valve replacement. The 39 pregnancies gave rise to 30 healthy babies. The small size of the series probably reflects both the increasing rarity ofyoung women with rheumatic heart disease in this country and the cautious attitude of their cardiologists. This makes it likely that these women represented the best end of the spectrum of cardiacfunction after valve replacement. Twenty-four pregnancies in 20 women who were not given anticoagulants produced 23 healthy babies and 1 spontaneous abortion. This group comprised 6 patients with free aortic homografts, 1 patient with a freefascia lata aortic valve, 2 with a Starr Edwards aortic valve, 7 with mounted mitral homografts, 1 with a fascia lata mitral valve, 1 with a Beall tricuspid prosthesis, 1 with a combined mitral homograft and Starr Edwards aortic prosthesis, and 1 with mitral and aortic frame-mounted fascia lata valves. There were no maternal deaths or thromboembolic complications in this group which included 5 patients who were in atrial fibrillation. Fifteen pregnancies in 14 women who received anticoagulants gave rise to 7 healthy babies. The fetal losses were one stillbirth, one intrauterine death at 34 weeks, and 3 spontaneous abortions; one surviving child has hydrocephalus as a result of blood clot and there were 2 maternal deaths. This group included 13 patients with Starr Edwards valves, 11 mitral and 2 aortic. A patient with a Hammersmith mitral valve was the only one to have been treated with heparin and her valve thrombosed. One patient with a mounted mitral homograft had a cerebral embolus. Nine of these patients were in atrialfibrillation. In 3 additional patients the valve replacement was carried out during pregnancy. Two of the patients survived operation. In one of these who was treated with warfarin the pregnancy gave rise to a congenitally malforned baby who died in the neonatal period. The baby born to the mother who did not receive anti-coagulants has a harelip and talipes. Women with artificial valves can tolerate the haemodynamic load of pregnancy well, but there is an increased fetal wastage in patients taking oral anticoagulants. This is probably largely attributable to fetal haemorrhage but there is also a risk of malformation caused by a teratogenic effect of warfarin. Experience gained in non-pregnant patients suggests that withholding anticoagulants in pregnant patients with prosthetic valves would usually be undesirable but warfarin should be avoided. The advantages of biological valves were apparent in this series. Although rheumatic heart disease has become rare of child-bearing age who have had valve replace-among our indigenous youth, its prevalence in many ments. These women need to know the risks of parts of the world remains unchanged and the pregnancy and the chances of having a healthy increasing frequency with which artificial valves are baby,...

Anticoagulation of Pregnant Women With Mechanical Heart Valves

“…The 3 questionnaires, [12][13][14] 6 case reports, [3][4][5][6]15,16 and 3 case series 10,17,18 that did not fulfill the eligibility criteria were excluded from further analysis. Therefore, 28 articles (6 cohort studies and 22 case series) were included in the final analysis.…”

Cardiac disease in pregnancy

“…Cardiopulmonary bypass is associated with an increased risk to the fetus but no increased risk to the mother. One consequence of the increasing safety of heart valve replacement has been an increase in the number of young people with prosthetic heart valves (Oakley and Doherty, 1976 One final problem relating to patients with valve or congenital heart disease is the risk of infective endocarditis. Endocarditis is most uncommon following normal delivery but it may follow complicated deliveries.…”

A successful pregnancy outcome after mitral valve replacement: a case report

“…1 In a study 39 pregnancies in 34 patients after valve replacement gave rise to 30 healthy babies. 2 This makes it likely that these women represented the best end of the spectrum of cardiac function after valve replacement. 2 The risk of thromboembolism, miscarriage, and premature birth is felt to be higher in patients who have prosthetic heart valves requiring anticoagulation.…”