Pregnancy Complicated by Valvular Heart Disease: An Update

ardiovascular disease complicates %1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. Although its prevalence is considered relatively low in pregnant women, heart disease is the most common cause of maternal mortality. Because more women with congenital or acquired heart disease are reaching childbearing age due to improved medical and surgical care, and desire children, the incidence of cardiovascular disease in pregnancy is increasing. The onset of pregnancy in patients with significant congenital or acquired valvular heart disease (VHD) presents challenges to their management. Despite significant advances in diagnosis, medical and surgical therapy of VHD, the course for many of these patients during and after pregnancy can be fraught with significant adverse events for both the mother and fetus. Many patients with significant VHD often are not aware of their diagnosis prior to pregnancy and the diagnosis is made when the hemodynamic challenges of pregnancy presents clinical symptoms. The objective of this review is to address preconception counseling, risk assessment, and management issues related to the care of women of childbearing age with VHD who are pregnant or may become pregnant.