Table 82. Recommendations for treatment in acquired native VHD, during family planning and pregnancy217.
| Valve disease | Family planning Intervention |
Pregnancy | ||
|---|---|---|---|---|
| Maternal risk | Fetal risk | Intervention | ||
| Severe mitral stenosis MVA < 1.5 cm2 |
Consider PBMV or surgery: NYHA FC III/IV or NYHA FC I/II + SPAP > 50 mmHg or Recent onset AF |
Increased risk: NYHA FC III/IV and/or AF |
Prematurity Restricted intrauterine growth Fetal loss Increased if NYHA FC III/IV |
Betablocker Diuretic Anticoagulation if AF If refractory maternal NYHA FC III/IV consider PBMV or surgery |
| Severe aortic stenosis AVA ≤ 1 cm2 |
Consider balloon valvuloplasty or surgery: Symptomatic or Asymptomatic + Altered ergometry test or LVEF < 50% or AVA < 0.7 cm2 mean gradient > 60 mmHg or Bicuspid valve + diameter of the aorta > 45mm |
Increased risk Heart failure Arrhythmia Syncope Sudden death Aortic dissection |
Complications Prematurity Restricted intrauterine growth Fetal loss |
Rest Use of diuretics is controversial Consider betablocker or calcium channel blocker + Anticoagulation if AF Consider balloon valvuloplasty or surgery if heart failure or syncope |
| Severe mitral regurgitation |
Consider surgery (repair/prosthesis): NYHA FC ≥ II or Asymptomatic + LVEF ≤ 60% + SPAP ≥ 50 mmHg + LVSD ≥ 40 mm |
Heart failure AF Increased risk if LVEF < 35% |
Low risk | Diuretic, vasodilator Digoxin, betablocker Consider surgery or percutaneous mitral repair if refractory heart failure |
| Severe aortic regurgitation |
Consider surgery: Symptomatic NYHA FC ≥ II or Prognostic factors LVEF < 50% LVDD > 70 mm (75 if rheumatic) LVSD > 50 mm (55 if rheumatic) Consider intervention in proximal aorta: Isolated bicuspid valve and diameter of the aorta > 45 mm |
Low risk if asymptomatic and normal LVEF Risk of heart failure if NYHA FC > II and/or AF or LVEF < 35% |
Low risk | Diuretic, vasodilator, Digoxin Consider surgery if refractory heart failure Consider intervention in proximal aorta: Isolated bicuspid valve and diameter of the aorta > 45 mm |
AF: atrial fibrillation; AVA: aortic valve área; PBMV: percutaneous balloon mitral valvuloplasty; FC: functional class; LVDD: left ventricular diastolic diameter; LVEF: left ventricular ejection fraction; LVSD: left ventricular systolic diameter; MVA: mitral valve area; SPAP: systolic pulmonary artery pressure.