简介：Managementofrheumaticmitralregurgitationinawomancontemplatingpregnancypresentsuniquechallengesfortheclinician.Whentaskedwithtakingcareofthistypeofpatient,attentionneedstobepaidtothepatient’sfunctionalstatustodetermineifsymptomsarepresent.Inadditiontothisclinicalassessment,transthoracicechocardiographyisalsocritical.Itprovidesinsightintotheetiologyofthemitralregurgitation,assessesforthepresenceofconcomitantmitralstenosisorothervalvularabnormalities,characterizestheseverityofmitralregurgitationthroughanintegrativeapproachandidentifieshighriskfindingsincludingprogressiveleftventricular(LV)dilationandLVdysfunction.SurgicalinterventionisrecommendedforsymptomaticpatientsandinasymptomaticpatientswithevidenceofprogressiveLVdilationandaLVejectionfractionoflessthan60%.Whilethepresenceofpulmonaryhypertensionandatrialfibrillationhavebeenshowntoberiskfactorsindegenerativemitralregurgitation,thesamehasnotbeendemonstratedinrheumaticmitralvalvedisease.Whilemitralregurgitationmaybereasonablywelltoleratedduringpregnancy,symptomaticpatientsareathigherriskforadversematernalandfetaloutcomes,andtherefore,itisrecommendedthatmitralvalvesurgerybeperformedpriortopregnancy.Oncethedecisionhasbeenmadetoproceedtosurgery,mitralrepair,performedataHeartValveCenterofExcellenceisrecommendedifpossibleduetoimprovedoutcomes.Mitralvalverepairispossiblein>80%casesofrheumaticmitralregurgitation.Ifrepairisnotpossible,replacementwitheitherabioprostheticormechanicalvalvearereasonableoptions.Thereareadvantagesanddisadvantagestoeachapproachandthechoiceofprosthesisshouldbeashareddecisionbetweenthepatientandhertreatmentteam.