PREGNANCY AND PROSTHETIC HEART-VALVES - A FRENCH COOPERATIVE RETROSPECTIVE STUDY OF 155 CASES

A French cooperative retrospective study analysed 155 pregnancies in 1 03 women with prosthetic heart valves: 95 mechanical prosthesis (MP) a nd 60 bioprostheses (BP). Among them 13 MP and 10 BP were bivalvular a nd four were mixed implants. In all, 182 (108 MP and 74 BP) prostheses were exposed to the risk of pregnancy. Among the 108 MP-bearing patie nts, 16 thromboembolic accidents (TEA) were recorded; 10 thromboses in 13 mitral, two aortic and one pulmonary MP. TEA were four times more frequent under oral anticoagulant therapy. Among the 74 BP, seven suff ered premature valve failure. Ninety-nine infants were born to 50 MP-b earing women (53%) and 48 BP-bearing patients (80%) (P<0.001). Twenty miscarriages were reported; they occurred more often under anticoagula nt treatment (17%) than without it (4%) P<0.02). Coumarin-induced embr yopathies were rare (only one definitively identified). Because pregna ncy with an MP under anticoagulant therapy is dangerous for the mother and may effect the fetus, the therapeutic indications for women of ch ild-bearing age must be taken into consideration. In a women already w ith an MP at the time of conception, the duration of heparin therapy s hould be limited to the following two periods: from the 6th to the 12t h week (coumarin-induced embryopathies) and during the last 2 weeks of gestation (haemorrhages during delivery and the neonatal period).