000001 WCC & IVUS 2015 Choosing the Treatment Option for - PowerPoint PPT Presentation

000001 WCC & IVUS 2015

Choosing the Treatment Option for Valvular Heart Disease in Child Bearing Age Group Dr. Amaresh M. Rao Nizam’s Institute of Medical Sciences 000001 WCC & IVUS 2015

INTRODUCTION  Severe valvular lesions likely to cause problems during pregnancy should be corrected before pregnancy by treatments which avoid valve replacement- balloon valvuloplasty for mitral stenosis, mitral valve repair for mitral valve prolapse.  If valve replacement is required the choice of prosthetic valve is difficult. 000001 WCC & IVUS 2015

BIO PROSTHETIC VALVE ANTICOAGULATION 000001 WCC & IVUS 2015

CHOICE OF PROSTHETIC HEART VALVE • Durability of prosthesis • Necessity for anticoagulation • Risk of thrombo- embolism & bleeding • Re- operation rate • Hemodynamic performance • Possible future pregnancy. 000001 WCC & IVUS 2015

METHODOLOGY  This is a retrospective analytical study.  52 patients admitted during 2010-2015 with diagnosed heart valve pathology in a single unit at our institution was made.  Age group of 15-45 years chosen for study. 000001 WCC & IVUS 2015

RESULTS bioprosthetic, 2 valve repair, 9 mechanical, 41 Type of valve 000001 WCC & IVUS 2015

• Out of 41 of these patients 16 are reinterventions • 2 are post bioprosthetic structural valve degeneration • 2 are post CMV , 2are post MV repair,6 post PBMV • 2 are pannus formation on mechanical valve , 1 with thrombus on a mechanical valve • 1 was AVR for aortic valve continued rheumatic disease post MVR where mitral prosthesis was normal. 000001 WCC & IVUS 2015

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000001 WCC & IVUS 2015

000001 WCC & IVUS 2015

000001 WCC & IVUS 2015

000001 WCC & IVUS 2015

DISCUSSION  Pregnancy is a pro-coagulant state due to an elevation in circulating pro-coagulant factors and maternal hormones, leading to decrease in PT, aPTT, TT and INR.  Selection of PHV in women during their childbearing age is still problematic , because an ideal valve is not available.  Patients with mechanical valves need close monitoring of warfarin therapy during pregnancy. 000001 WCC & IVUS 2015

 Substitution of warfarin with IV unfractionated heparin in the first 6 to 12 weeks and last 2 weeks of pregnancy is associated with a low rate of warfarin embryopathy and of bleeding in the mother and baby.  Women who need 5 mg of warfarin or less are probably at low risk for fetal warfarin embryopathy and may be able to receive warfarin throughout pregnancy.  In women who are not interested in anticoagulation or for whom follow up is not possible, a tissue valve is preferred. 000001 WCC & IVUS 2015

CONCLUSION  Selection of prosthetic heart valve for women of childbearing age remains difficult and needs to be individualised.  Meticulous monitoring must be emphasized. 000001 WCC & IVUS 2015

THANK YOU 000001 WCC & IVUS 2015