Valve Replacement During Pregnancy

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Abstract
The normal physiologic response to pregnancy includes a rise in the resting cardiac output of 30% to 50%, 30% increase in blood volume, 20% increase in O2 consumption, and an increase in the heart rate of 15%. in the pregnant female with underlying heart disease the consequence of these changes to the successful termination of pregnancy vary according to the severity of the cardiac condition. Maternal mortality may rise to 18% with a fetal mortality up to 40%. Non-operative management is preferable and may be successful in most cases. Closed mitral valvulotomy was performed as a semi-emergency procedure in the pregnant cardiac patient for many years. Extracorporeal circulation during pregnancy for the repair of congenital heart defects and open mitral valvuloplasty was carried out from time to time but usually for brief periods. The patient discussed in the present report was a 35 year old female with severe mitral regurgitation and biventricular failure. Successful termination of the pregnancy was deemed unlikely without cardiac surgical intervention. Surgery was carried out using extracorporeal circulation and the mitral valve was successfully replaced with a Starr-Edwards prosthesis. Convalescence was uncomplicated as was the remainder of the pregnancy. The patient carried out a subsequent full term normal delivery without incident and with a normal infant. Anticoagulation with heparin was maintained throughout the last 2 trimesters because of the known hazard of coumadin anticoagulation which is associated with a high incidence of fetal hemorrhage. The present case illustrates that reparative open-heart surgery may be successfully performed in the pregnant cardiac patient without deleterious effects.
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