Artificial Heart Valves In Pregnancy

Risks of artificial heart valves in pregnancy. 1. 2. 3. 4. 5. Structural failure of valve Heart failure Thromboembolism Bleeding due to anticoagulation Infection

AHV Maybe Bioprosthetic or Mechanical Bioprosthetic values do not require Anticoagulation but have higher incidence of valve failure than mechanical valves. Valve failure may be due to: 1. Leaflet degeneration, resulting in regurgitation. 2. Progressive valve calcification leading to stenosis.

Mechanical heart valves are associated with increased incidence of thromboembolic events during pregnancy hence the therapeutic anticoagulation throughout pregnancy is mandatory. Factors that increase thromboebmolic risk include 1. 2. 3. 4. History of prior thromboembolic event. AF Prosthesis in mitral area. Multiple prosthetic valves.

Management of Pregnant Women With Artificial HV

Although data are insufficient to make definite recommendations on method of therapeutic anticoagulation during pregnancy, a staged therapy approach is suggested to balance fetal teratogenic risk and maternal thromboembolic risk (UPTODATE : FEB 17,2011) During first trimester LMWH (eg: Exoxaparin 1mg/kg s/c every 12 hours) or UFH initiated before 6th week of gestation, with dose adjusted to achieve peak anti Xa level(approximately 1.0 u/ml) at 4 hours after s/c injection of LMWH or mid dose aPTT at least twice control measured at least weekly with UFH. LMWH is preferred to UFH for its more predictable anticoagulant effect.

Preferred options for anticoagulation between 12th to 36th week are warfarin & LMWH. Warfarin dose is adjusted to maintain an INR of 2.5 to 3.5 measured every 2 weeks.. Patient is shifted to LMWH or VFH from 36th week until delivery. Addition of LDA (75 to 100g/d) until a week prior to planned delivery is suggested.