Valvular Heart Disease in Pregnancy: Anticoagulation and the Role of Percutaneous Treatment

Rahul Gupta, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA. Electronic address: [email protected].
Aaqib H. Malik, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.
Purva Ranchal, Department of Internal Medicine, Boston University, MA.
Wilbert S. Aronow, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.
Apurva V. Vyas, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA. Electronic address: [email protected].
Yasotha Rajeswaran, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA. Electronic address: [email protected].
Joanne Quinones, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA. Electronic address: [email protected].
Amy M. Ahnert, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA. Electronic address: [email protected].

Abstract

Valvular heart disease is present in about 1% of pregnancies, and it poses a management challenge as both fetal and maternal lives are at risk of complications. Pregnancy is associated with significant hemodynamic changes, which can compromise the cardiac status in women with underlying valvular disorders. Management of valvular heart diseases has undergone considerable innovation and advancement with newer techniques, approaches and devices being employed. The decision regarding the management of anticoagulation, especially in patients with prosthetic valves, raises distinct questions and challenges. In this review, we describe the management of common valvular heart diseases encountered during pregnancy, role of percutaneous catheter based therapeutic interventions, the importance of a team-based approach, and the challenges given existing gaps in the literature.