Prothetic valve and pregnancy

  I was born with aortic stenosis, I had my valve replaced in 1990 with a Medtronic Hall prosthetic valve, My question is: Is it safe to become pregnant? I am curently on Coumadin. My OB/GYN feels it is safe to take heparin injections for the first trimester and then go back on coumadin.  He has had several patients do well.  My cardiologist feels that there is to much of a risk of a clot forming on my valve on heparin, however he was thinking I would be on heparin my entire pregnancy. I would like another opinion before making a decesion.    

[CCF CARDIO MD DLB]

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Dear Holly
There is controversy as to the best way to handle women such as yourself. There is a greater risk of the valve clotting on heparin (potentially a fatal event), but there is a greater risk of fetal malformation with the coumadin. Your valve is slightly less likely to clot than older types of valves. I prefer heparin over coumadin while the woman is trying to conceive, during pregnancy (especially in the first trimester) and at the onset of labor (every cardiologist agrees with this part). I am aware that some cardiologists allow coumadin for the entire pregnancy (except labor) and some allow it during pregnancy after the first trimester.
I hope this has been useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.