The presentation I prepared for Northside Hospital Heart Institute's Heart of the Matter conference earlier this year focused on valvular heart disease (VHD) in pregnancy, including hemodynamic changes, preconception counseling, risk assessment, specific regurgitant or stenotic lesions, valve interventions, labor and delivery (L&D) and post-partum follow-up. Physiological hemodynamic changes of pregnancy, including an increase in cardiac output, stroke volume and heart rate, as well as a decrease in systemic vascular resistance (SVR), can lead to cardiac decompensation and complications in women with VHD. I emphasized the importance of preconception counseling, clinical testing (e.g., echocardiographic assessment and exercise testing) and risk.
Assessment and monitoring to ensure these patients are well-informed before conception. Several risk assessments and prediction indices can be used, along with guidance on subsets of patients who should be advised against pregnancy altogether. Each regurgitant and stenotic lesion was discussed in detail, along with options for preconception and post-conception interventions.
The presentation concluded with key takeaways on VHD in pregnancy, which are provided here.
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