From the Guidelines
Mitral valve prolapse (MVP) during pregnancy is generally well-tolerated with minimal complications for most women, and those with uncomplicated MVP typically don't require special treatment during pregnancy. Women with significant mitral regurgitation or symptoms should be monitored more closely by both an obstetrician and cardiologist throughout pregnancy 1. The physical findings pertinent to MVP may be obscured or varied by the physiological changes of pregnancy, especially the increased blood volume and reduced systemic vascular resistance 1. Associated MR can usually be managed medically, although on rare occasions, MV surgery is required because of ruptured chordae and acute, severe worsening of the regurgitant lesion 1.
Key Considerations
- Medical management includes diuretics for the rare patient with pulmonary congestion, and vasodilator therapy is indicated only in the presence of concomitant systemic hypertension 1.
- Angiotensin-converting enzyme inhibitors are considered unsafe and are contraindicated because of their multiple adverse effects on fetal development 1.
- Hydralazine is an agent generally considered safe for use during pregnancy 1.
- When MV surgery is required, repair is always preferred, as would be the case for any young patient but especially in relation to the desirability of avoiding the potential need for anticoagulation 1.
Monitoring and Treatment
- Women with severe mitral regurgitation should have regular echocardiograms to monitor cardiac function, typically once per trimester.
- Labor and delivery can generally proceed normally, though epidural anesthesia may be preferred to minimize cardiovascular stress.
- Postpartum monitoring is important as the rapid fluid shifts after delivery can temporarily increase cardiac workload 1.
Outcome
- Most women with MVP have successful pregnancies without major cardiovascular complications, and the prognosis of pregnancy in women with mitral valve prolapse is excellent unless the regurgitation is severe and poorly tolerated 1.
From the Research
Complications from MVP with Pregnancy
- Mitral valve prolapse (MVP) is generally considered a benign condition, but it can be complicated in patients with severe mitral valve prolapse, particularly during pregnancy 2.
- Women with MVP in the absence of other cardiovascular disorders typically tolerate pregnancy well and do not develop remarkable cardiac complications 2.
- However, serious complications of MVP, including arrhythmia, infective endocarditis, and cerebral ischemic events, can occur during pregnancy 2, 3.
- The prognosis of pregnant patients with MVP may be closely related to the pathological and functional changes of the mitral valve 2.
- Non-myxomatous MVP poses little to no obstetric risks in terms of pregnancy, labor, and neonatal complications, whereas myxomatous MVP is a major etiology of valvular heart disease in women of childbearing age 2.
- Pregnant women with MVP are at increased risk of adverse cardiac outcomes, including cardiac arrest, arrhythmia, stroke, heart failure, and coronary artery dissection, compared to women without MVP 4.
- MVP in pregnancy is also associated with higher obstetric risks, including preterm delivery and preeclampsia/hemolysis, elevated liver enzymes, and low platelets syndrome 4.
- The management of MVP during pregnancy may involve surgical interventions, medicinal treatment with β-blockers, and prophylactic antibiotics, although debates remain regarding the use of these treatments 2, 3.
- Echocardiography plays a crucial role in the management of patients with MVP, including diagnosis, prognosis, and monitoring of complications 5.