| Highest risk conditions
(Pregnancy contraindicated unless condition is corrected) | • Symptomatic mitral stenosis
• Symptomatic aortic stenosis
• Sever coartication
• Peripartum Cardiomyopathy with residual LV dysfunction
• Symptomatic heart failure with LVEF ˂30%
• Pulmonary arterial hypertension
• Bicuspid AV with ascending aorta enlargement >50 mm |
| --- | --- |
| | • valve repair should be performed prior to pregnancy whenever possible.
• Lifelong avoidance of pregnancy is recommended in patients with a highest-risk condition that is not amenable to correction ex: PHTN and LVEF <30% |
hemodynamic changes of pregnancy involve an increase in blood volume and up to a 50% increase in cardiac output by the second trimester . These changes can be poorly tolerated in the setting of valvular disease, placing both the mother and unborn infant at substantial risk of morbidity and mortality.
<aside> 💡 Stenotic valvular disease is generally more poorly tolerated than regurgitant valvular disease.
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Beta blockers slow heart rate to increase left ventricular filling time and reduce left atrial pressure and may be used to manage relatively mild mitral stenosis during pregnancy. Medical management is also often appropriate for other relatively lower-risk valvular diseases (eg, mitral regurgitation, aortic regurgitation) during pregnancy; however, it is inadequate to prevent complications for symptomatic mitral stenosis, and surgical repair is needed.
Although less common than mitral stenosis in women of childbearing age, symptomatic aortic stenosis is also one of the highest-risk cardiac conditions during pregnancy and should be surgically corrected prior to pregnancy.