Table 85. Treatment in prosthesis dysfunction during pregnancy.

Biological prosthesis		Mechanical prosthesis
Maternal risk	Fetal risk	Maternal risk	Fetal risk
Dysfunction with predominant regurgitation, NYHA FC I/II and normal LVEF Consider pharmacological measures	Low risk	Dysfunction with mild to moderate “paravalvular” regurgitation, without significant hemolysis or severe heart failure Consider pharmacological measures for heart failure and anemia Severe MR or significant hemolysis Consider intervention Heart failure and/or symptomatic hemolysis Consider percutaneous closure of the paravalvular leak or surgery (high risk of relapse)	High fetal risk, if surgery
Dysfunction with predominant valve stenosis and calcification (mitral, aortic, or tricuspid) Risks of severe heart failure, shock, sudden death Always consider percutaneous or transapical (valve-in-valve) implantation or surgery	High fetal risk Fetal loss Prematurity	Mechanical prosthesis thrombosis Consider emergency intervention (thrombolysis or surgery) Mechanical prosthesis stenosis due to intravalvular endothelial growth – pannus or mismatch Need for intervention is rare If necessary, consider surgery	High fetal risk, if surgery

FC: functional class; LVEF: left ventricular ejection fraction; MR: mitral regurgitation.