Pregnancy presents a unique set of problems for women with prosthetic heart valves. These replacements may be mechanical or bioprosthetic (heterografts or homografts).
Mechanical heart valves are associated with an increased incidence of thromboembolic events during pregnancy. Therapeutic anticoagulation throughout pregnancy is essential to reduce the risk of thromboembolic complications , but given the absence of adequate prospective controlled trials, the preferred anticoagulant regimen is uncertain [2-4]. Maternal and fetal complications associated with the different anticoagulant regimens in women with mechanical and prosthetic valves and management guidelines are reviewed here . (See 'Anticoagulation during pregnancy for women with mechanical heart valves' below.)
Bioprosthetic valves typically do not require anticoagulation (unless there are other thromboembolic risk factors), but bioprostheses have a significantly higher incidence of valve failure than mechanical valves. This may be of particular concern for young women, who must consider the potential for future valve surgery if they have a bioprosthesis. (See "Management of patients with prosthetic heart valves" and 'Structural failure of bioprosthetic valves' below.)
Management of pregnant women with prosthetic heart valves, including anticoagulant therapy is discussed here. Antimicrobial prophylaxis in patients with prosthetic heart valves is discussed separately. (See "Antimicrobial prophylaxis for bacterial endocarditis".)
RISKS OF PROSTHETIC VALVES IN PREGNANCY
Prosthetic heart valves are associated with a variety of complications, including structural failure of the valve, infection, heart failure, thromboembolism, and bleeding due to anticoagulation. The overall incidence of complications in appropriately managed, nonpregnant patients with prosthetic valves is approximately 3 percent per year. (See "Complications of prosthetic heart valves".)