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and anatomical selection criteria.194,584 Valve treatment should be performed for patients with AR meeting the criteria for valve intervention before any elective intermediate- or high-risk NCS.966,967
15.3 Peri-operative monitoring
Heart rate control (particularly in MS) and careful fluid management (particularly in AS and MR with reduced LVEF) are needed throughout the procedure. The involvement of specialized cardiovascular anaesthesiologists should be considered in complex situations because TOE monitoring may be considered. Pulmonary artery catheterization is not routinely used.
16 Management of valvular heart
disease during pregnancy
Specific ESC Guidelines on this topic are available (the 2025 ESC Guidelines on cardiovascular disease during pregnancy) and should be consulted for further details.968 Pregnancies in patients with VHD should be considered high risk and managed under the close supervision of a cardiologist and a multidisciplinary Pregnancy Heart Team. The importance of midwives and other specialized nursing personnel is increasingly recognized for high-quality direct patient interactions. Shared decisionmaking is especially important when addressing the cardiovascular risk of pregnancy and the benefit–risk ratios of therapeutic options and modes of delivery (Figure 22).
16.1 Management before pregnancy
Ideally, women should undergo a thorough physical examination by their general practitioner for VHD screening prior to pregnancy. A specialized evaluation including TTE should be performed by a cardiologist in the case of clinical suspicion.968,969 If VHD is diagnosed, pre-pregnancy counselling is imperative. Unplanned pregnancies in patients with VHD should be discouraged. Contraception methods should be recommended after discussion with the patient in the presence of a significant maternal and/or foetal risk. In patients contemplating pregnancy, the maternal risk should be assessed using the modified WHO classification and other scores such as the CARPREG or DEVI risk score (see Supplementary data online, Table S7).970
Figure 22 The Pregnancy Heart Team model of care. AS, aortic stenosis; ECG, electrocardiogram; MS, mitral stenosis; TTE, transthoracic echocardiography; VHD, valvular heart disease. Downloaded from academic.oup.com/eurheartj/article/46/44/4635/8234488 by guest on 07 October 2026
