Korean J Thorac Cardiovasc Surg.
1999 Nov;32(11):1023-1030.
Pregnancy in Patients with Prosthetic Heart Valve
- Affiliations
-
- 1Division of Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
- 2Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
- 3Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. bcchang@yumc,yonsei.ac.kr
Abstract
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BACKGROUND: This is a retrospective study of 42 pregnancies from 33 women with prosthetic heart valves
who were on anticoagulation regimen prior to or during their pregnancy.
MATERIAL AND METHOD: Of the 17 women with bioprosthesis, 15 had 21 pregnancies following
cessation of the anticoagulation therapy which resulted in the delivery of 20 healthy babies
and 1 abortion. Remaining 2 had 3 pregnancies maintained with heparin, resulting in 2 healthy
babies and 1 spontaneous abortion.
RESULT: Among 16 women with mechanical heart valves, there were 7 pregnancies during which
warfarin was used and this was associated with 4 fetal wastages(2 therapeutic abortion,
1 spontaneous abortion and 1 stillbirth with cerebral hemorrhage). However, in pregnancies
where heparin was used, there was no fetal wastage. A patient who did not take anticoagulant
for the first trimester and took warfarin for the remaining period and a patient who did not
take anticoagulant during pregnancy delivered normal babies. There was an other fetal wastage
in a patient on anti-platelet therapy for the first trimester and warfarin therapy for the
remaining periods. There was 1 minor petechial complication in a heparin administered group.
CONCLUSION
The study indicates that woman with bioprosthetic heart valves can go through pregnancy without undue risks or complications. On the other hand, the use of warfarin during pregnancy in women with mechanical heart valves, was shown to be associated with unacceptable high risk for the fetus. However, in the same group of women, judicious use of heparin during pregnancy was accompanied by a much reduced risk. The safety and adequate therapeutic range of heparin usage under such circumstances are subject to further studies.
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