000001 WCC & IVUS 2015
Choosing the Treatment Option for Valvular Heart Disease in Child Bearing Age Group Dr. Amaresh M. Rao Nizam’s Institute of Medical Sciences 000001 WCC & IVUS 2015
INTRODUCTION Severe valvular lesions likely to cause problems during pregnancy should be corrected before pregnancy by treatments which avoid valve replacement- balloon valvuloplasty for mitral stenosis, mitral valve repair for mitral valve prolapse. If valve replacement is required the choice of prosthetic valve is difficult. 000001 WCC & IVUS 2015
BIO PROSTHETIC VALVE ANTICOAGULATION 000001 WCC & IVUS 2015
CHOICE OF PROSTHETIC HEART VALVE • Durability of prosthesis • Necessity for anticoagulation • Risk of thrombo- embolism & bleeding • Re- operation rate • Hemodynamic performance • Possible future pregnancy. 000001 WCC & IVUS 2015
METHODOLOGY This is a retrospective analytical study. 52 patients admitted during 2010-2015 with diagnosed heart valve pathology in a single unit at our institution was made. Age group of 15-45 years chosen for study. 000001 WCC & IVUS 2015
RESULTS bioprosthetic, 2 valve repair, 9 mechanical, 41 Type of valve 000001 WCC & IVUS 2015
• Out of 41 of these patients 16 are reinterventions • 2 are post bioprosthetic structural valve degeneration • 2 are post CMV , 2are post MV repair,6 post PBMV • 2 are pannus formation on mechanical valve , 1 with thrombus on a mechanical valve • 1 was AVR for aortic valve continued rheumatic disease post MVR where mitral prosthesis was normal. 000001 WCC & IVUS 2015
000001 WCC & IVUS 2015
000001 WCC & IVUS 2015
000001 WCC & IVUS 2015
000001 WCC & IVUS 2015
000001 WCC & IVUS 2015
DISCUSSION Pregnancy is a pro-coagulant state due to an elevation in circulating pro-coagulant factors and maternal hormones, leading to decrease in PT, aPTT, TT and INR. Selection of PHV in women during their childbearing age is still problematic , because an ideal valve is not available. Patients with mechanical valves need close monitoring of warfarin therapy during pregnancy. 000001 WCC & IVUS 2015
Substitution of warfarin with IV unfractionated heparin in the first 6 to 12 weeks and last 2 weeks of pregnancy is associated with a low rate of warfarin embryopathy and of bleeding in the mother and baby. Women who need 5 mg of warfarin or less are probably at low risk for fetal warfarin embryopathy and may be able to receive warfarin throughout pregnancy. In women who are not interested in anticoagulation or for whom follow up is not possible, a tissue valve is preferred. 000001 WCC & IVUS 2015
CONCLUSION Selection of prosthetic heart valve for women of childbearing age remains difficult and needs to be individualised. Meticulous monitoring must be emphasized. 000001 WCC & IVUS 2015
THANK YOU 000001 WCC & IVUS 2015
Recommend
More recommend
