[Pregnancy in patients with heart valve prosthesis. Retrospective study apropos of 40 pregnancies].

In order to be able to offer pregnant artificial heart valve patients a practical management approach enabling reduction of maternal and fetal risks, the authors evaluated 40 pregnancies in 24 women. Thirty one valves had been inserted prior to these pregnancies: 24 mechanical valves and 7 biological valves. Different types of anticoagulation regimens were used in 32 pregnancies, while 8 took place without the use of anticoagulants (biological valves in sinus rhythm). From a clinical standpoint, almost all these pregnancies brought to term took place without cardiac decompensation. They resulted in the birth of 26 live infants, including one premature. One child was born at term with a phocomelia-type malformation and two were stillborn. There were five therapeutic abortions and six spontaneous abortions. There were four cases of thromboses of the artificial valve, three of which occurred in patients on heparin (dose of 5,000 IU/12 h). Three massive thromboses required emergency valve replacement surgery. There were also three embolic accidents, including one which regressed totally in a few hours. Two hemorrhagic complications occurred with subcutaneous heparin during the post-partum period. In practice, we feel that: when a young woman wishing to become pregnant requires valve replacement, a biological device is preferable; oral anticoagulants are contra-indicated during the first three months of pregnancy; the dose of 5,000 IU/12 h of heparin is insufficient to prevent thrombo-embolic accidents; when a mechanical valve is already implanted, the sequential treatment protocol of subcutaneous heparin--oral anticoagulant--subcutaneous heparin, with an initial dose of heparin of 5,000 IU/12 h then adjusted on the basis of APTT, is the best choice.