State of the Art Management of Mechanical Heart Valves During Pregnancy

  • Shivani R. AggarwalEmail author
  • Katherine E. Economy
  • Anne M. Valente
Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pregnancy and Cardiovascular Disease


Purpose of the review

To review the management of women with mechanical heart valves during pregnancy, from preconception counseling through delivery with a summary of the latest guidelines.

Recent findings

The hypercoagulability of pregnancy combined with the imperfect choices of anticoagulant agents contribute to a high risk of complications in pregnant women with mechanical heart valves. Valve thrombosis remains a major concern, much of which occurs during the first trimester transition to heparin-based products. The safest method of anticoagulation, with the best balance of maternal and fetal risk, is use of low-dose vitamin K antagonists, but only if therapeutic anticoagulation can be achieved with warfarin doses of ≤ 5 mg/day.


Management of mechanical heart valves in pregnancy remains fraught with difficult decisions involving balancing of maternal and fetal risks as well as a high risk of maternal and fetal complications. Preconception counseling and planning is imperative. A risk-benefit discussion with the patient will help guide the choice of anticoagulation and outline the plan for safe delivery options. A multidisciplinary approach to management is advisable with close follow-up and care in a tertiary center.


Pregnancy Mechanical heart valves Valvular heart disease Congenital heart disease 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Shivani R. Aggarwal
    • 1
    • 2
    Email author
  • Katherine E. Economy
    • 3
  • Anne M. Valente
    • 1
    • 2
  1. 1.Department of CardiologyBoston Children’s HospitalBostonUSA
  2. 2.Department of Medicine, Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonUSA
  3. 3.Department of Obstetrics and Gynecology, Division of Maternal Fetal MedicineBrigham and Women’s HospitalBostonUSA

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