ABSTRACT
Hemodynamic changes of pregnancy can lead to clinical decompensation of women with valvular heart disease due to increases in cardiac output, intravascular volume expansion, and a drop in systemic vascular resistance. The leading causes of aortic stenosis in pregnant women are bicuspid aortic valve disease, often associated with dilation of the ascending aorta, followed by rheumatic heart disease (RHD). In bicuspid aortic valve disease, ascending aortic diameters should be assessed before, during, and after pregnancy to rule out worsened dilation. The most common cause of mitral regurgitation (MR) in pregnant women in developed countries is mitral valve prolapse, followed by RHD. The causes of aortic regurgitation (AR) include bicuspid aortic valve disease, aortopathies leading to ascending aorta and aortic annular dilatation (i.e., Marfan's), infective endocarditis, and RHD. Pregnant women with mild to moderate MR/AR are recommended to get follow-up every trimester with more frequent follow-up for severe regurgitant lesions based on symptoms.
