Pregnancy Outcomes in Women With Regurgitant Valve Lesions

Introduction: Pregnancy outcomes in women with significant regurgitant valve lesions have not been well defined. The primary objective of this study is to determine the frequency of maternal adverse cardiac events in pregnant women with significant regurgitant valve lesions. We also aim to describe obstetric and fetal/neonatal adverse outcomes in this population. Methods: Women with heart disease enrolled in a prospective study on pregnancy outcomes (Toronto and Vancouver, Canada) with moderate or greater regurgitant valve lesion were included. Women with coexisting significant stenotic lesions were excluded. Multivalve disease was defined as more than one regurgitant valve lesion. Adverse maternal cardiac events included: pulmonary edema or right heart failure requiring treatment, sustained or symptomatic tachyarrhythmia requiring treatment, cardiac arrest, or cardiac death. Results: There were 462 completed pregnancies in women with moderate or greater valvular regurgitation (mean maternal age 29.6 ± 5.7 years); 73% (337/462) of women had congenital heart disease and 13% (59/462) had rheumatic heart disease. Pregnancies were classified according to the most significant regurgitant valve lesions: systemic atrioventricular (AV) valve regurgitation (n=149), subpulmonary AV valve regurgitation (n=91), aortic valve regurgitation (n=44), pulmonary valve regurgitation (n=104), and multivalve regurgitation (n=74). Adverse cardiac events complicated 13% (61/462) of pregnancies. Among pregnancies in women with isolated regurgitant valve lesions, adverse maternal cardiac events occurred in 15% of women with systemic AV valve regurgitation, 13% with subpulmonary AV valve regurgitation, 5% with aortic regurgitation and 4% with pulmonary regurgitation. Adverse cardiac events were highest in women with multivalve disease (27%). Adverse fetal/neonatal and obstetric complications occurred in 22% and 9% of pregnancies, respectively. Conclusions: Women with moderate or greater AV valve regurgitation are at risk for cardiac complications during pregnancy. Pregnancies in women with aortic and pulmonary valve regurgitation are usually well tolerated. Women with more than one regurgitant valve lesion are at highest risk for complications.