Prosthetic Valves in Pregnancy

Prosthetic valves have been widely used in patients with valvular heart disease irrespective of their etiologies. Advances in surgical technique, prosthetic valve design and material, and anticoagulantion, there are increasing numbers of women with prosthetic valves reaching to childbearing age. The two types of prosthetic valve widely used are the bioprosthetic valve and the mechanical heart valve and critical complications can occur in both valves. Although bioprosthetic valves do not require anticoagulation, they have limited durability, particularly in the younger patient, and acceleration of bioprostheses degeneration during pregnancy has been reported. On the other hand, mechanical heart valves have long-term durability but require lifelong anticoagulation, even in pregnancy and the postpartum period. Since pregnancy is a procoagulant state, pregnant women with mechanical heart valves are exposed to an increased risk of valve thrombosis. In addition, warfarin has potential teratogenic effect for the fetus in the first trimester, although warfarin is the most effective antigoagulant for preventing valve thrombosis in pregnant women with mechanical heart valves. The both guidelines published from the US and Euro advocate recommendations for this unique population. In this session, we will summarize the risks of pregnancy in patients with prosthetic valves and the effective anticoagulant strategies for pregnant women with mechanical heart valves.