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Jun 12, 2023 373 likes •567 views

000001 WCC & IVUS 2015 Choosing the Treatment Option for Valvular Heart Disease in Child Bearing Age Group Dr. Amaresh M. Rao Nizams Institute of Medical Sciences 000001 WCC & IVUS 2015 INTRODUCTION Severe valvular lesions

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Choosing the Treatment Option for Valvular Heart Disease in Child Bearing Age Group

Dr. Amaresh M. Rao

Nizam’s Institute of Medical Sciences

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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.

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BIO PROSTHETIC VALVE ANTICOAGULATION

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CHOICE OF PROSTHETIC HEART VALVE

Durability of prosthesis
Necessity for anticoagulation
Risk of thrombo- embolism & bleeding
Re- operation rate
Hemodynamic performance
Possible future pregnancy.

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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.

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RESULTS

bioprosthetic, 2 mechanical, 41 valve repair, 9

Type of valve

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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.

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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.

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 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.

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CONCLUSION

 Selection of prosthetic heart valve for women of childbearing age remains difficult and needs to be individualised.  Meticulous monitoring must be emphasized.

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THANK YOU

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