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Forum Name: Valvular Heart Diseases

Question: I have MVP w/ moderate R & PCOS related infertility, HE


 emmylala2003 - Thu Dec 16, 2004 1:25 pm

I am 28yrs old, married, female with PCOS related infertility (among other symptoms) I have recently been diagnosed with mitral valve prolapse w/ moderate regurgitation as well, in the past I have had symptoms of heart palpitations, skipped beats, shortness of breath, anziety and paraesthesia. My husband and I were planning on starting a family soon and made arrangements to see a fertility specialist to become pregnant. However, now that I have the MVPwMR I'm not sure if it would be wise to take fertility medication or to become pregnant at all. I'm not sure about the specifics of my MVPwMR, just that the regurgitation is moderate and that I will have to see my cardiologist annually, I spoke to my cardiologist briefly about fertility med's and pregnancy and she didnt seem concerned. Doctor, please advise on what you would suggest I do to make the right decision. Please, I'm so confused. Will I definately need surgery in the future because my Moderate regurgitation might progress to Severe? will taking fertility med's worsen the condition? will be pregnant worsen the condition? What are the chances I would need surgery during pregnancy? Is there a chance I could lose the baby or my life with this condition, during pregnancy? Please help! thank you
 Dr. Yasser Mokhtar - Sun Dec 26, 2004 1:49 pm

User avatar Dear Emmylala2003,

It is unpredictable whether or not and how much mitral regurgitation with mitral valva prolpase may progress. The only way to find out is follow up.

Pregnancy, no doubt, poses a big burden on all the organs of the body including the circulation and the heart. The maximum load on the heart is around the 26-28th week of pregnancy.

You did not mention what was your ejection fraction and what were the dimensions of the left ventricle and left atrium on the echocardiogram. If both were normal, this means that your heart function is normal and your heart has not been affected by the mitral regurge yet. If your left ventricle was dilated anc the ejection fraction was normal, this means that your heart is starting to be affected by the mitral regurge and still your heart function is normal. If your left ventricle is dilated and the ejection fraction is low then your heart function has been affected as well.

How does this translate to your case?
1. If your heart function is normal then there is no need to be worried and you can go ahead and get pregnant but you will have to be followed by your cardiologist closely, so if you live a small town ir far away from where your cardiologist is, it might be a problem towards the end of your pregnancy because you will have to see him more often. Patients who have mitral regurgitation usually tolerate pregnancy well.
2. If your heart function was abnormal, it is not impossible to get pregnant but you will have to be followed very frequently and may be hospitalized towards the end of your pregnancy to be followed up more closely.

About you needing surgery during pregnancy for mitral valve, you have to be elvaluated before conception and if you are thought to need surgery for mitral valve repair or replacement, then it should be done before pregnancy.

From what you said, your cardiologist does not seem to be impressed by your mitral valve condition, otherwise, i believe, she would have taken further steps for better evaluating your condition and making sure that you are going to tolerate pregnancy well without any problems.

Of course you don't have to get pregnant right away, you can always wait for a year or so and see how your mitral valve prolapse and regurgitation both progress and then make your decision.

If you still have more concerns or questions, please don't hesitate to post them.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 emmylala2003 - Tue Dec 28, 2004 4:11 pm

This is my report from my cardiologist.

Pulmonary Pressure: RVSP 21

Aortic Root - 2.7

Left Atrium - 2.5

Left Ventr.End Systolic Dimension: 2.5

Left Ventr.End Dystolic Dimension: 4.2

Left Ventr.Posterior Wall Thickness - Systolic: 1.1

Left Ventricular Septal Thickness- Systole: 0.9

Left Vent. Function: looks like m 1, I can't really read the first letter.

I also exercised to a Stage IV of a Bruce with no significant EKG changes and reached a heart rate of 186.

Blood Pressure 120/70.

What do you think?
 Dr. Yasser Mokhtar - Wed Dec 29, 2004 10:23 am

User avatar Dear Emmylala2003,

Thank you very much for the update.

i am not at all worried. The echocardiogram report looks absolutely normal. i have not seen so many people running on the treadmill and getting to stage 4 on the Bruce protocol, you are very physically fit.

i think that your heart can handle a lot of stress including that of pregnancy.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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