Valve disease in pregnancy

Optimal Management of a Pregnant Patient with Rheumatic Heart Disease

“…In general, when caring for parturients with valvular lesions, a cesarean delivery should be reserved for obstetric indications only,1,2 as it is associated with more blood loss, increased risk of wound infection, post-operative immobility, and thrombosis 1. Euvolemia should be maintained with strict monitoring of intake and output.…”

“…Rheumatic heart disease remains the number one worldwide cause of maternal cardiac complications in pregnancy 1. Since symptoms of rheumatic fever typically do not present until the fourth or fifth decade, the pathophysiologic changes associated with pregnancy may cause as many as 25% of these women to first experience symptoms during pregnancy.…”

“…In patients with rheumatic heart disease, mitral stenosis is the most common heart lesion 1. When these patients become pregnant, the hypervolemia and increased HR can increase the transmitral pressure gradient, leading to increased left atrial volume and pressure.…”

“…Pressure can be transmitted to the pulmonary vasculature, resulting in pulmonary edema and in severe cases pulmonary hypertension, a significant risk during pregnancy as it can cause right heart failure 4. Further, the chronically dilated left atrium has a propensity to disrupt the cardiac conducting system and cause supraventricular tachycardia, 1 a detrimental event in patients with mitral stenosis who rely on the atrial kick to augment preload. Overall, these factors often cause the previously undiagnosed and asymptomatic patient to develop symptoms during pregnancy, and, in severe cases, experience profound cardiac decompensation.…”

Infective endocarditis in pregnant women

“…ИЭ характеризуется пестро-той клинических проявлений, зачастую тяжелым течени-ем и ассоциируется с высоким риском развития тяжелой клапанной дисфункции, сердечной недостаточности (СН), тромбоэмболических осложнений и летального ис-хода [9,10].…”