Native Valve Stenosis in Pregnancy: Difference between revisions
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==Recommendations== | ==Native Valve Stenosis in Pregnancy<ref name="pmid24603192">{{cite journal |vauthors=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD |title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines |journal=J. Am. Coll. Cardiol. |volume=63 |issue=22 |pages=2438–88 |year=2014 |pmid=24603192 |doi=10.1016/j.jacc.2014.02.537 |url=}}</ref>== | ||
===Recommendations=== | |||
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==Diagnosis and Follow-up== | ===Diagnosis and Follow-up=== | ||
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==Medical Therapy== | ===Medical Therapy=== | ||
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==Intervention== | ===Intervention=== | ||
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==References== | |||
Revision as of 21:53, 27 October 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Native Valve Stenosis in Pregnancy[1]
Recommendations
| Class I |
| "1. All patients with suspected valve stenosis should undergo a clinical evaluation and TTE before pregnancy.(Level of Evidence: C)" |
| "2. All patients with severe valve stenosis (stages C and D) should undergo prepregnancy counseling by a cardiologist with expertise in managing patients with VHD during pregnancy.(Level of Evidence: C)" |
| "3. All patients referred for a valve operation before pregnancy should receive prepregnancy counseling by a cardiologist with expertise in managing patients with VHD during pregnancy about the risks and benefits of all options for operative interventions, including mechanical prosthesis, bioprosthesis, and valve repair.(Level of Evidence: C)" |
| "4. Pregnant patients with severe valve stenosis (stages C and D) should be monitored in a tertiary care center with a dedicated Heart Valve Team of cardiologists, surgeons, anesthesiologists, and obstetricians with expertise in the management of high-risk cardiac patients during pregnancy.(Level of Evidence: C)" |
Diagnosis and Follow-up
| Class IIa |
| "1. Exercise testing is reasonable in asymptomatic patients with severe AS (aortic velocity ‡4.0 m per second or mean pressure gradient ‡40 mm Hg, stage C) before pregnancy. (Level of Evidence: C)" |
Medical Therapy
| Class I |
| "1. Anticoagulation should be given to pregnant patients with MS and AF unless contraindicated.(Level of Evidence: C)" |
| Class IIa |
| "1. Use of beta blockers as required for rate control is reasonable for pregnant patients with MS in the absence of contraindica-tion if tolerated. (Level of Evidence: C)" |
| Class IIb |
| "1. Use of diuretics may be reasonable for pregnant patients with MS and HF symptoms (stage D). (Level of Evidence: C)" |
| Class III (Harm) |
| "1. ACE inhibitors and ARBs should not be given to pregnant patients with valve stenosis (Level of Evidence: B)" |
Intervention
| Class I |
| "1. Valve intervention is recommended before pregnancy for symptomatic patients with severe AS (aortic velocity ≥4.0 m per second or mean pressure gradient ≥40 mm Hg, stage D). (Level of Evidence: C)" |
| "2. Valve intervention is recommended before pregnancy for symptomatic patients with severe MS (mitral valve area ≤1.5 cm2, stage D)(Level of Evidence: C)" |
| "3. Percutaneous mitral balloon commissurotomy is recommended before pregnancy for asymptomatic patients with severe MS (mitral valve area ≤1.5 cm2, stage C) who have valve morphology favorable for percutaneous mitral balloon commissurotomy.(Level of Evidence: C)" |
| Class IIa |
| "1. Valve intervention is reasonable before pregnancy for asymp- tomatic patients with severe AS (aortic velocity ≥ 4.0 m per second or mean pressure gradient ≥ 40 mm Hg, stage C). (Level of Evidence: C)" |
| "2. Percutaneous mitral balloon commissurotomy is reasonable for pregnant patients with severe MS (mitral valve area ≤1.5 cm2, stage D) with valve morphology favorable for percutaneous mitral balloon commissurotomy who remain symptomatic with NYHA class III to IV HF symptoms despite medical therapy (Level of Evidence: B)" |
| "3. Valve intervention is reasonable for pregnant patients with severe MS (mitral valve area ≤1.5 cm2, stage D) and valve morphology not favorable for percutaneous mitral balloon commissurotomy only if there are refractory NYHA class IV HF symptoms. (Level of Evidence: C)" |
| "4. Valve intervention is reasonable for pregnant patients with se- vere AS (mean pressure gradient ≥40 mm Hg, stage D) only if there is hemodynamic deterioration or NYHA class III to IV HF symptoms (Level of Evidence: B)" |
| Class III (Harm) |
| "1. Valve operation should not be performed in pregnant patients with valve stenosis in the absence of severe HF symptoms. (Level of Evidence: C)" |
References
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J. Am. Coll. Cardiol. 63 (22): 2438–88. doi:10.1016/j.jacc.2014.02.537. PMID 24603192.