Pregnancy in 20 Patients with Bioprosthetic Valve Replacement

Núñez, Lisardo; Larrea, J.L.; Aguado, M. Gil; Reque, J.A.; Matorras, Roberto; Mínguez, J.

doi:10.1378/chest.84.1.26

Cited by 25 publications

(10 citation statements)

References 14 publications

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“…Most of the women in this study with a bioprosthesis went through pregnancy successfully without anticoagulant treatment. The fetal outcome was excellent and our data for this group do not differ from the normal population.6 This accords with previous reports.3 [7][8][9] The outcome was only slightly less favourable for the babies of mothers with mechanical valves. The difference did not reach statistical significance, except for prematurity.…”

Section: Mechanical Valvessupporting

confidence: 91%

Outcome of pregnancy in women with valve prostheses.

Sbarouni

1994

Heart

279

124

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(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)

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Section: Mechanical Valvessupporting

confidence: 91%

Outcome of pregnancy in women with valve prostheses.

Sbarouni

1994

Heart

279

124

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“…Increased risk to the fetus is related primarily to oral anticoagulants during the first trimester. 6,9 The incidence of spontaneous abortion in our study was 6%, much lower than in other studies with rates of 15% to 23.4%. 19 The low rate of spontaneous abortion in our series was attributed to lower doses of warfarin required to maintain optimal anticoagulation.…”

Section: Discussioncontrasting

confidence: 75%

“…This necessitates heart valve replacement at a young age. 6,7 The ideal choice of prosthesis for women of c h i l d b e a ri n g a g e i s s t i l l u n r e s o l ve d d e s p i t e advancements in the design of prosthetic heart valves. A mechanical prosthesis although durable and with an excellent hemodynamic performance, requires lifelong a n t i c o a g u l a t i o n t o p r eve n t t h r o m b o e m b o l i c complications.…”

Section: Discussionmentioning

confidence: 99%

Effect of Oral Anticoagulant during Pregnancy with Prosthetic Heart Valve

Srivastava

Gupta

Singh

et al. 2002

Asian Cardiovasc Thorac Ann

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This retrospective study aimed to evaluate the risks and outcome of oral anticoagulant use during pregnancy in women with prosthetic heart valves. Between December 1989 and November 1998, 192 females of childbearing age underwent heart valve replacement with a mechanical prosthesis. There were 37 pregnancies in 30 patients during follow-up. Pregnancy was terminated on medical grounds in 5 cases, there were 2 (6%) spontaneous abortions, and 1 (3%) premature birth of a normal baby who died 24 hours later due to asphyxia. The other 29 pregnancies (91%) went to full term and the mothers continued taking oral anticoagulants until a week before the expected date of delivery, then switched to heparin. There was no thromboembolism, valve thrombosis, or maternal mortality. Three babies (10%) had a skeletal deformity: nasal hypoplasia in all 3, with cleft pinna in 1. Continuation of oral anticoagulants during pregnancy provided adequate protection against thromboembolism and valve thrombosis, but the risks of fetal abnormalities and premature delivery should be explained to women of childbearing age with a mechanical valve prosthesis.

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“…From the obstetric point of view, most authors consider the biological prosthesis as being the more suitable one [5,8], In the Mayo Clinic, for instance, since 1973 women of reproductive age generally receive biologi cal valves instead of metal valves [5], Our experience with them has been very satisfac tory by all means [8], We had no fetal com plications and only one maternal complica tion that resolved easily.…”

Section: Biological Prosthesismentioning

confidence: 95%

Prosthetic Heart Valve and Pregnancy

Matorras¹,

Reque²,

Usandizaga³

et al. 1985

Gynecol Obstet Invest

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We studied 59 pregnancies in 48 female carriers of prosthetic heart valves. In 44 pregnancies the mother had a metal valve mostly with coumarin therapy and in 15 a bioprosthesis usually without hematologic treatment. In the patients with metal prostheses we had the following maternal complications: 1 maternal death, 3 valve thromboses, 2 heart failures and puerperal hemorrhage. There was also a significantly increased rate of preterm, low birth weight infants and intrauterine growth retardation. Concerning malformations we found only 2 cases of mild nasal hypoplasia. Regarding the complications of bioprosthesis, we had only 1 case of paroxysmal tachycardia and no fetal complications. Comparing the results we came to the conclusion that pregnancy is much better tolerated in patients with bioprostheses and that in patients with metal prostheses the risk is increased if the mother is older than 30 years, if time of replacement is more than 5 years or if there is a history of previous thromboembolism or gravidic heart failure.

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Pregnancy in 20 Patients with Bioprosthetic Valve Replacement

Cited by 25 publications

References 14 publications

Outcome of pregnancy in women with valve prostheses.

Outcome of pregnancy in women with valve prostheses.

Effect of Oral Anticoagulant during Pregnancy with Prosthetic Heart Valve

Prosthetic Heart Valve and Pregnancy

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