Valvular Disease in Women

There are very few studies on valvular heart disease in women. There is a sex influence in the prevalence of some types of valve disease: it is well known that rheumatic mitral stenosis is very common in women but degenerative valve disease affects both sexes in a similar way. In degenerative aortic stenosis several physiopathological differences have been reported in women: the amount of calcium is lower than in men and the left ventricle generates higher gradients and hypercontractile response in women. Regarding prognosis it is well accepted that women have higher mortality rates than men in cardiac surgery, both in coronary surgery and in valvular surgery. The ultimate reasons for this increased mortaliy are not known. Pregnacy can be a difficult situation in women with valvular disease. In women with significant valve lesions it is wise to correct the valve disease before pregnancy is attempetd. Pregnancies in women with mechanical prosthesis carry an increased risk of prosthetic thrombosis as well as the risk of fetal embriopathy when oral anticoagulants are used in the first trimester.