Outcome of pregnancy in women with valve prostheses.

Abstract

(Br Heart3 1994;71:196-201) There is still no consensus on the most suitable heart valve replacement for women of childbearing age. Mechanical valves carry a risk of thromboembolism and the need for anticoagulation whereas bioprostheses have a lower thromboembolic risk but are not as durable, particularly in the young. There is controversy about the safest anticoagulant regimen during pregnancy. Early reports of pregnancy in women with mechanical valves were usually of anecdotal cases: they were inspired by disaster rather than by success. Most of these reports came from the United States where overanticoagulation was the rule because of the use of thromboplastins of low responsiveness.' There is still no universal adoption of the International Normalised Ratio (INR)

Pregnancy in patients with heart disease: Experience with 1,000 cases

“…Nevertheless, these data do not support the hypothesis that pregnancy accelerates the degeneration of bioprosthesis, [15][16] because in the majority of these cases some dysfunction was recognized before gestation. Indeed, the results of a contemporary prospective and comparative 5-year study did not indicate that pregnancy contributes to bioprosthesis deterioration, 17 consistent with findings in other studies.…”

Clinical outcomes of pregnant women with mechanical heart valves

“…Ancak bu ilaçlar mekanik kalp kapağı olan gebe hastalarda, fetal riskleri elimine ederken, mekanik kalp kapağını korumakta yetersiz kalarak anne için (dolayısıyla bebek için de) hayati riski olan tromboembolik komplikasyonlara yol açabilmektedir. Gebelik boyunca subkütan heparin, varfarin veya ilk trimesterde heparin-sonrasında varfarin tedavisinin sonuçlarını karşılaştırdıkları çalışmalarında Sbarouni ve ark., [11] varfarin tedavisini embriyopati ile ilişkili bulmazken, heparin tedavisini daha fazla tromboembolik ve kanama komplikasyonlarıyla ilişkili bulmuşlardır. Meschengieser ve ark., [12] oral antikoagülanların anne için subkütan heparinden daha güvenli olduğu, gebelik sonuçlarında da heparinin oral antikoagülanlara göre açık bir avantaj sağlamadığı sonucuna varmışlardır.…”

Adherence to a guideline for coumarins in pregnancy

“…Although the data are historic, we feel they are still instructive since the recommendations of the guideline are used for some well-defined indications during pregnancy. Heparin treatment carries a substantial risk for both valve thrombosis and bleeding complications in pregnant women with artificial heart valves 3,8 . In this situation, coumarins are preferred and the studied guideline is applied in many European countries 5,9 .…”