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Which type of heart valve replacement is better?

Q: My 22 years old wife is suffering from rheumatic heart disease and the doctor advised surgery to replace both the mitral and aortic valve. Which type of artificial valve (tissue valve or mechanical valve) should we choose? Will safe pregnancy be possible after the valve replacement? What are the risk factors to both the mother and the child?

A:Each of these two valves, that is tissue valve and mechanical valve have certain advantages and disadvantages. Tissue valve has the advantage that long term blood thinning tablets (anticoagulation) is not required) but the main disadvantage is that the life of these valves is limited to around 10-15 years in general. To the very contrary, mechanical valves are long lasting but blood-thinning tablets have to be taken life long. Considering you are young, I would feel that mechanical valve would be a better option so that you do not have to have repeated surgeries. Pregnancy can be safely managed even with a mechanical valve by being under regular care and supervision of a cardiologist, who may like to regulate your anti coagulation therapy during conception and subsequently during delivery. If one continues to take anticoagulation during conception, then there is small risk to the baby of being born with birth defects (Warfarin embryopathy). During pregnancy and during delivery, there is a small chance again of intra uterine (womb) bleeding and a slightly higher risk of abortion during anticoagulation therapy. However, these risks are relatively small and upwards of 90-95% of ladies go through a totally normal and uneventful pregnancy. Therefore if the need for valve surgery is absolute, then one must go through it, rather than risking undergoing a pregnancy before the valve surgery and then having heart failure or some such complications during delivery with a damaged valve. More specific queries can be directed to your cardiologist, who would be only to happy to answer them.

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