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Heart Valve Diseases in Pregnancy

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Heart Valve Disease

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Abstract

Various congenital or acquired valvular heart diseases (VHD) may be present in pregnant women, and may significantly increase the maternal and fetal risk associated with pregnancy. Pregnancy is associated with significant haemodynamic changes that may aggravate VHD, precipitate or exacerbate symptoms, and increase the risk of thrombo-embolic events. Cardiac imaging modalities, particularly echocardiography and cardiac magnetic resonance, are pivotal for the diagnosis and management of pregnant women with VHD. Valve lesions with a fixed cardiac output, such as severe mitral or aortic stenosis, are at greatest risk of decompensation, while regurgitant lesions are likely to be well tolerated, as the fall in vascular resistance compensates for the volume loading induced by pregnancy. Despite the increased risk, with appropriate cardiologic evaluation and treatment most pregnant women with VHD can successfully deliver healthy children. Women with moderate and high risk of complications during pregnancy should be evaluated in an expert center in VHD by a pregnancy multidisciplinary heart team.

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Abbreviations

AR:

Aortic regurgitation

AS:

Aortic stenosis

BAV:

Bicuspid aortic valve

BNP:

Brain natriuretic peptide

CHD:

Congenital heart disease

CMR:

Cardiac magnetic resonance

CT:

Computerized tomography

ECG:

Electrocardiogram

ESC:

European Society of Cardiology

HF:

Heart failure

IE:

Infective endocarditis

INR:

International normalized ratio

LMWH:

Low molecular weight heparin

LV:

Left ventricle/ventricular

MR:

Mitral regurgitation

MS:

Mitral stenosis

TR:

Tricuspid regurgitation

TTE:

Transthoracic echocardiography

UFH:

Unfractionated heparin

VHD:

Valvular heart disease

VKA:

Vitamin K antagonist

References

  1. Stout KK, Otto CM. Pregnancy in women with valvular heart disease. Heart. 2007;93(5):552–8.

    Article  Google Scholar 

  2. Rutherford JD. Heart failure in pregnancy. Curr Heart Fail Rep. 2012;9(4):277–81.

    Article  Google Scholar 

  3. Elkayam U, Goland S, Pieper PG, Silverside CK. High-risk cardiac disease in pregnancy: part I. J Am Coll Cardiol. 2016;68(4):396–410.

    Article  Google Scholar 

  4. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstrom-Lundqvist C, Cifkova R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA, ESC Scientific Document Group. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–241.

    Article  Google Scholar 

  5. Vistad I, Cvancarova M, Hustad BL, Henriksen T. Vaginal breech delivery: results of a prospective registration study. BMC Pregnancy Childbirth. 2013;13:153.

    Article  Google Scholar 

  6. Ouzounian JG, Elkayam U. Physiologic changes during normal pregnancy and delivery. Cardiol Clin. 2012;30(3):317–29.

    Article  Google Scholar 

  7. Thorne S. Pregnancy and native heart valve disease. Heart. 2016;102(17):1410–7.

    Article  Google Scholar 

  8. Hameed AB, Chan K, Ghamsary M, Elkayam U. Longitudinal changes in the B-type natriuretic peptide levels in normal pregnancy and postpartum. Clin Cardiol. 2009;32(8):E60–2.

    Article  Google Scholar 

  9. Tanous D, Siu SC, Mason J, Greutmann M, Wald RM, Parker JD, Sermer M, Colman JM, Silversides CK. B-type natriuretic peptide in pregnant women with heart disease. J Am Coll Cardiol. 2010;56(15):1247–53.

    Article  CAS  Google Scholar 

  10. Diao M, Kane A, Ndiaye MB, Mbaye A, Bodian M, Dia MM, Sarr M, Monsuez JJ, Ba SA. Pregnancy in women with heart disease in sub-Saharan Africa. Arch Cardiovasc Dis. 2011;104(6-7):370–4.

    Article  Google Scholar 

  11. Haththotuwa HR, Attygalle D, Jayatilleka AC, Karunaratna V, Thorne SA. Maternal mortality due to cardiac disease in Sri Lanka. Int J Gynaecol Obstet. 2009;104(3):194–8.

    Article  Google Scholar 

  12. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline 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. J Am Coll Cardiol. 2014;63(22):e57–185.

    Article  Google Scholar 

  13. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;70(2):252–89.

    Article  Google Scholar 

  14. Lau ES, Scott NS. Valvular heart disease and pregnancy. Curr Treat Options Cardiovasc Med. 2018;20(6):46.

    Article  Google Scholar 

  15. van Hagen IM, Thorne SA, Taha N, Youssef G, Elnagar A, Gabriel H, ElRakshy Y, Iung B, Johnson MR, Hall R, Roos-Hesselink JW. Pregnancy outcomes in women with rheumatic mitral valve disease: results from the registry of pregnancy and cardiac disease. Circulation. 2018;137(8):806–16.

    Article  Google Scholar 

  16. Hameed A, Karaalp IS, Tummala PP, Wani OR, Canetti M, Akhter MW, Goodwin I, Zapadinsky N, Elkayam U. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001;37(3):893–9.

    Article  CAS  Google Scholar 

  17. van Hagen IM, Thorne SA, Taha N, Youssef G, Elnagar A, Gabriel H, ElRakshy Y, Iung B, Johnson MR, Hall R, Roos-Hesselink JW, Investigators R, Team E. Pregnancy outcomes in women with rheumatic mitral valve disease: results from the registry of pregnancy and cardiac disease. Circulation. 2018;137(8):806–16.

    Article  Google Scholar 

  18. Orwat S, Diller GP, van Hagen IM, Schmidt R, Tobler D, Greutmann M, Jonkaitiene R, Elnagar A, Johnson MR, Hall R, Roos-Hesselink JW, Baumgartner H. Risk of pregnancy in moderate and severe aortic stenosis: from the multinational ROPAC registry. J Am Coll Cardiol. 2016;68(16):1727–37.

    Article  Google Scholar 

  19. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Munoz D, Rosenhek R, Sjogren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91.

    Article  Google Scholar 

  20. Tzemos N, Silversides CK, Colman JM, Therrien J, Webb GD, Mason J, Cocoara E, Sermer M, Siu SC. Late cardiac outcomes after pregnancy in women with congenital aortic stenosis. Am Heart J. 2009;157(3):474–80.

    Article  Google Scholar 

  21. Goldstein SA, Ward CC. Congenital and acquired valvular heart disease in pregnancy. Curr Cardiol Rep. 2017;19(10):96.

    Article  Google Scholar 

  22. Lesniak-Sobelga A, Tracz W, KostKiewicz M, Podolec P, Pasowicz M. Clinical and echocardiographic assessment of pregnant women with valvular heart diseases—maternal and fetal outcome. Int J Cardiol. 2004;94(1):15–23.

    Article  Google Scholar 

  23. Drenthen W, Boersma E, Balci A, Moons P, Roos-Hesselink JW, Mulder BJ, Vliegen HW, van Dijk AP, Voors AA, Yap SC, van Veldhuisen DJ, Pieper PG. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010;31(17):2124–32.

    Article  Google Scholar 

  24. Drenthen W, Pieper PG, Ploeg M, Voors AA, Roos-Hesselink JW, Mulder BJ, Vliegen HW, Sollie KM, Ebels T, van Veldhuisen DJ. Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries. Eur Heart J. 2005;26(23):2588–95.

    Article  Google Scholar 

  25. Bhagra CJ, D’Souza R, Silversides CK. Valvular heart disease and pregnancy part II: management of prosthetic valves. Heart. 2017;103(3):244–52.

    Article  CAS  Google Scholar 

  26. van Hagen IM, Roos-Hesselink JW, Ruys TP, Merz WM, Goland S, Gabriel H, Lelonek M, Trojnarska O, Al Mahmeed WA, Balint HO, Ashour Z, Baumgartner H, Boersma E, Johnson MR, Hall R. Pregnancy in women with a mechanical heart valve: data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation. 2015;132(2):132–42.

    Article  Google Scholar 

  27. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075–128.

    Article  Google Scholar 

  28. Kebed KY, Bishu K, Al Adham RI, Baddour LM, Connolly HM, Sohail MR, Steckelberg JM, Wilson WR, Murad MH, Anavekar NS. Pregnancy and postpartum infective endocarditis: a systematic review. Mayo Clin Proc. 2014;89(8):1143–52.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Denisa Muraru

  2. Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy

    Denisa Muraru

  3. Cardiac Division, Department of Echocardiography, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton Hospital, London, UK

    Elena Surkova

Authors
  1. Denisa Muraru
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  2. Elena Surkova
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Editor information

Editors and Affiliations

  1. Hospital Universitario Ramón y Cajal, Madrid, Spain

    Jose Zamorano

  2. Cardiology, University Hospital Sart Tilman Cardiology, Liège, Belgium

    Patrizio Lancellotti

  3. University of Liège, Liège, Belgium

    Luc Pierard

  4. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec Heart & Lung Institute, QC, Canada

    Philippe Pibarot

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Muraru, D., Surkova, E. (2020). Heart Valve Diseases in Pregnancy. In: Zamorano, J., Lancellotti, P., Pierard, L., Pibarot, P. (eds) Heart Valve Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-23104-0_17

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  • DOI: https://doi.org/10.1007/978-3-030-23104-0_17

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23103-3

  • Online ISBN: 978-3-030-23104-0

  • eBook Packages: MedicineMedicine (R0)

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