Percutaneous balloon mitral valvotomy in pregnancy using the Inoue balloon catheter

Treatment of valvular heart disease during pregnancy for improving maternal and neonatal outcome

BACKGROUND

Valvular heart disease constitutes the majority of all causes of heart disease in pregnancy. In the presence of valvular heart disease, the necessary haemodynamic changes of pregnancy might cause heart failure, leading to severe maternal and fetal morbidity and even mortality. Treatment of valvular heart disease is indicated when patients experience a deterioration of symptoms and in case of a severe valvular lesion. Whether medical therapy or interventional therapy is the optimal treatment for both mother and child is unclear.

OBJECTIVES

To assess effectiveness and adverse effects of the different treatment modalities of valvular heart disease in pregnancy to improve maternal and neonatal outcomes.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), EMBASE (1980 to 23 March 2011) and the reference lists of background review articles.

SELECTION CRITERIA

Randomised controlled trials, quasi-randomised controlled and cluster-randomised controlled trials comparing medical therapy with percutaneous or surgical intervention for the treatment of valvular heart disease in pregnancy.

DATA COLLECTION AND ANALYSIS

We identified no (randomised) controlled trials to assess the effectiveness and adverse effects of the treatment of valvular heart disease in pregnancy.

MAIN RESULTS

There were no randomised controlled trials, quasi-randomised controlled trials or cluster-randomised trials identified from the search strategy.

AUTHORS' CONCLUSIONS

There is insufficient evidence to define the most effective treatment of valvular heart disease in pregnancy to improve maternal and neonatal outcomes.

Acquired Heart Disease in Pregnancy

The incidence of rheumatic heart disease in most industrialized countries is decreasing. Those women who have regurgitant lesions will commonly experience an improvement in symptoms, and therapy is required only in the most severe cases. Women with mild to moderate stenotic lesions can usually expect a good outcome to pregnancy, but women with severe stenotic lesions require close monitoring by both their obstetricians and their cardiologists, especially during the third trimester, labour and delivery, and the early postpartum period. This is the third in a series of five articles reviewing in detail the assessment and management of specific cardiac disorders in pregnancy.

Valvular heart disease in pregnancy. A contemporary perspective

Valvular heart disease may have a significant impact on the course and outcome of pregnancy with implications for fetal as well as maternal health. Optimally, serious symptomatic valvular heart disease should be detected and treated before pregnancy. Whether a pregnant woman is known to have valvular heart disease or is diagnosed during pregnancy, it is imperative that she is managed by an experienced multidisciplinary team. Although medical therapy may alleviate symptoms of heart failure in some patients, definitive intervention either with percutaneous balloon valvuloplasty or with surgical valve replacement may be necessary.