Catheter-based interventions in women with heart disease during pregnancy

Heart disease during pregnancy is being recognized as an important cause of maternal as well as fetal morbidity and mortality. Improved treatment of congenital heart disease (CHD) in childhood has resulted in an increased number of women with heart disease reaching childbearing age. Although CHD is now the most common structural cardiac abnormalities encountered in women of childbearing age in developed countries, valvular heart disease still remains worldwide the most common indications for cardiac intervention during pregnancy. Transcatheter aortic valve replacement (TAVR) offers a theoretical advantage over surgical aortic valve replacement in pregnancy in patients with severe aortic stenosis with moderate to heavily calcified valve or with moderate-to-severe aortic regurgitation, or in degenerated bioprosthetic valve. There are three reported cases of TAVR during pregnancy, two in women with bio-prosthetic valve degeneration and one in native bicuspid aortic valve with prior balloon valvuloplasty and moderate aortic regurgitation.