Valvular disease
Native valvular disease
Valvular disease may present for the first time during pregnancy. Stenotic lesions that limit the
ability to increase cardiac output may not be well tolerated during pregnancy and delivery. Regurgitant
lesions are generally better tolerated.
Women with severe valve disease and who wish to consider pregnancy require careful multidisciplinary
discussion and counselling. If valve repair is not possible and replacement is required, then
several factors need to be considered when making an individualised decision between a tissue and
mechanical prosthesis. Mechanical valves have longer durability, but they require full anticoagulation.
Whilst tissue valves do not require anticoagulation, the lifespan of the prosthesis is limited, and women
of childbearing age will usually require redo surgery. It is not clear whether pregnancy may accelerate
degeneration of the valve, and therefore younger women may require a redo valve replacement before
further pregnancies. For those with previous sternotomies, the risk of inevitable further surgery if a
bioprosthesis is used must be weighed against the risk of warfarin anticoagulation for a mechanical
valve particularly if further pregnancies are contemplated. Further, to achieve the advantages of
durability of a mechanical prosthesis, good compliance with anticoagulation is necessary, and therefore
patients who are poorly compliant with anticoagulation may be safer and achieve longer durability
with a tissue valve