Mitral Repair 02/2019, now contemplating pregnancy

[Miriam83]

Hi everybody,
I'm a 38yo from Austria and here I couldn't find anyone so far who became pregnant after mitral repair.
In 2018, my valve had deteriorated from prolapse with moderate insufficiency to severe regurgitation with flail leaflet during my first pregnancy. One of my doctors suspected the deterioration to be due to pregnancy hormones which soften body tissue.
When my daughter was 3 months old I had the mitral repair.
In theory, it shouldn't be a problem to have another child with a repaired valve. Still I'm unsure, as I can't find any data.
My cardiologist said I shouldn't worry, but she doesn't know anyone who had a child after mitral repair nor any studies regarding the risk of deterioration during pregnancy after mitral repair.

Even if I maybe won't find answers to my questions, I'm glad I found this forum! Thanks to everybody for all your contributions.

 

[dornole]

Hello and welcome to the forum! I also had mitral problems that were first discovered while I was pregnant, in my case, severe mitral stenosis. They think it is rheumatic heart damage from a former strep infection which went into the severe range due to the increased blood flow needed to carry twins. I went to the hospital coughing up blood.

For the life and health of both myself and the twins I had an emergency C-section at 27 weeks, and then three months later I had a repair, which in my case was a valvuloplasty balloon to open the stenotic valve. This left me with moderate stenosis and moderate regurgitation, and I'm still at moderate or mod-severe stenosis and regurg now, depending on which figures you prioritize. This was 20 years ago, and yes the 2-lb twins are doing great now. Rough though, 5 days in ICU for me, 4 months in NICU for them, and two years of constant round the clock care for them at home to pull them through. Had to quit my job AND hire a nanny to help me. (I have three older kids as well who were age 1, 3, and 5 at the time).

We had already decided we were done with kids after the twins - in fact I had a tubal ligation planned for my post-delivery hospital stay. But in the hospital the (very agitated) perinatologist who was doing the delivery (along with a cardiologist, a cardiac anesthesiologist, two pediatricians, and like 12 other people) shook his finger at me and said "No more babies!" Then whipped around to my husband and said "YOU take care of that!" (FWIW, we had no idea I had ANY issues prior to this). So I was not in the same position that you are, trying to decide. But I will say this:

--Remember the strain that a pregnancy puts on your heart with the extra blood flow that is needed. It WILL be more pressure on your valve and might cause issues even if it functions perfectly now (does it?). In addition, I coded during the delivery and so did my son. I'm not saying your situation is the same, but I would not take it lightly either. I'd ask your cardiologist what specific changes and pressures they'd expect to see on your valve from pregnancy, theoretically speaking. I would ask your surgeon who did your repair the same question. Would you need to change any medications like Warfarin or aspirin? What are the risks of that?

--I would do a consult with a perinatologist who specializes in high-risk deliveries before you make your decision. If anyone knows anyone who has given birth post-mitral-repair, it would be them. I would want to be followed by a perinatologist for my whole pregnancy in your situation and have them put together a team for the delivery. I'd think about worst-case too. Do you live in a metro area with access to a NICU if you need to deliver early? If your health deteriorated prior to fetal viability, have you considered what happens then? If you died, would your daughter be cared for? Not to say these things will happen, but I think it's prudent to look at them with clear eyes and get information from a couple of medical perspectives and decide the cost-benefit. If the perinatologist says "no problem" in addition to your cardiologist and surgeon, I think you're probably good. They are a cautious bunch where pregnancy is concerned.

Hope this helps, there are not too many preggers valvers on this board. I believe a couple of people have given birth post AVR, if not post-repair? Hoping they will chime in.

 

[Miriam83]

Thank you for your clear words!

 

[ValveAdmin]

Hi Miriam, welcome to the forum. Best wishes!

 

[JBranham]

Hi! I had my son in 2018. I did have my aortic heart valve replaced in 2016. My high risk OBGYN was concerned because of the coumadin I was taking. We made a plan and he took me off coumadin and I was on Lovenox injections for the rest of my pregnancy. I had my son via C-section. The only problem I had was after the C-Section when they removed the stitches. I had 2 hematomas. I ended up back in the hospital for a week being monitored. It took a little while to heal but everything is fine now. I hope this helps.

 

[Miriam83]

Thank you, JBranham! I'm glad everything worked out well (although it must have been quite difficult to be back in hospital after birth)

 

[Chuck C]

Welcome to the forum Miriam.

Sorry that I don't have any experience in this area, but glad that a couple have given their thoughts, who had to deal with pregnancy and heart valve issues. Dornole's advice to consult with a perinatologist who specializes in high-risk deliveries sounds like very sound advice to me.

The delivery for our second daughter had serious complications requiring an emergency c section and hysterectomy, leaving my wife unable to have any more children. We wanted one more child and chose to adopt a little girl who had been orphaned. She was 4 years old, an age at which they are much harder for the adoption agencies to place, as most people want babies. It was a wonderful experience, and we love her every bit as much as our biological children. I share this only to give encouragement that, if you do decide that the risks of pregnancy are too great, there are other options for having more children if that is your desire.

Wishing you wisdom in making the difficult decision which lies before you.

 

[Miriam83]

Thank you very much!

 

[carolinemc]

Hi! I had my son in 2018. I did have my aortic heart valve replaced in 2016. My high risk OBGYN was concerned because of the coumadin I was taking. We made a plan and he took me off coumadin and I was on Lovenox injections for the rest of my pregnancy. I had my son via C-section. The only problem I had was after the C-Section when they removed the stitches. I had 2 hematomas. I ended up back in the hospital for a week being monitored. It took a little while to heal but everything is fine now. I hope this helps.

I am surprised that you are still on Coumadin, for most of us got switched to Warfarin. Glad things went well with the delivery and the surprise come back into the hospital. Have a great day.

 

[JBranham]

I am surprised that you are still on Coumadin, for most of us got switched to Warfarin. Glad things went well with the delivery and the surprise come back into the hospital. Have a great day.

I was told Warfarin is the generic to Coumadin. I use Warfarin too. I go to the Coumadin Clinic to get my INR checked.

 

[carolinemc]

I was told Warfarin is the generic to Coumadin. I use Warfarin too. I go to the Coumadin Clinic to get my INR checked.

They no longer make Coumadin. So you are on warfarin completely. So glad you keep up with it as I do. Patent on Coumadin is out, no longer. So we are stuck with generic Warfarin. Good luck.

 

[Sheenas7]

I was on Coumadin for 20+ years and now I am on Jantoven. Cardiologist said is like Coumadin.

 

[Chuck C]

I was on Coumadin for 20+ years and now I am on Jantoven. Cardiologist said is like Coumadin.

Jantoven appears to be just another brand name for warfarin and Coumadin.

https://ufhealth.org/taking-warfari...Coumadin, Jantoven) is,may form a blood clot.

 

[carolinemc]

Jantoven appears to be just another brand name for warfarin and Coumadin.

https://ufhealth.org/taking-warfari...Coumadin, Jantoven) is,may form a blood clot.

Never heard of Jantoven, must be a European brand. For in the USA, we use the generic warfarin since we no longer can get Coumadin.

 

[dornole]

Actually just saw this on Tv ad here in us.