DEAR MAYO CLINIC: I found out during my pregnancy that I have mitral valve stenosis. How common is valve disease, and what should I know about it?

ANSWER: Valve disease affects how blood moves through the heart, and pregnancy is often a time when symptoms first appear or become more noticeable. Learning about a heart valve condition during pregnancy can be unexpected and overwhelming. Understanding why this happens and exploring treatment options can bring clarity and calm fears.

Pregnancy is often described as the body's ultimate cardiovascular stress test. The heart works significantly harder to support both the mother and the developing baby. Blood volume expands, vascular resistance drops and heart rate increases. These normal physiological changes begin early in pregnancy and peak in the late second to early third trimester.

These changes can unmask symptoms of previously silent valve disease or intensify those of known valve conditions because the heart is being asked to move more blood through a valve that isn't functioning normally. Known valve conditions include:

• Narrowed valves (stenosis)
• Leaky valves (regurgitation)
• Congenital valve abnormalities

Other valve conditions may result from infections, such as rheumatic fever, or changes in the valve's structure over time.

Symptoms

Even women who felt well before pregnancy may begin to notice symptoms around 28 to 30 weeks, when the cardiovascular system reaches its peak workload.

Many common pregnancy symptoms overlap with those of valve disease. Fatigue, shortness of breath, swelling and a faster heart rate can all occur in a healthy pregnancy. It's especially important to evaluate symptoms that begin suddenly or noticeably worsen.

Shortness of breath with activity or when lying flat, unusual fatigue that affects daily routines, swelling in the legs or feet, racing heartbeat, reduced exercise tolerance, or chest pressure should prompt a conversation with a clinician.

Because pregnancy symptoms can mask underlying cardiac issues, clear communication between patients and their care teams is essential. Many patients assume new symptoms are simply part of pregnancy, especially if previous pregnancies were uncomplicated. But when something feels off, listening to that instinct is important.

An assessment of symptoms may include:

• Physical exam.
• Echocardiogram to look at the heart's structure and function.
• Electrocardiogram (ECG) to check the heart's rhythm.
• Additional imaging or testing.

These evaluations help determine whether symptoms are pregnancy-related or caused by cardiac disease.

Treatment

Once valve disease is identified, coordinated care becomes especially important. Many patients benefit from a pregnancy heart team approach that includes specialists in cardiology and maternal-fetal medicine, with support from cardiac surgery or structural heart experts, if needed. Local obstetric teams may remain involved, particularly if delivery is expected to happen closer to home.

The pregnancy heart team approach helps align medical needs with a patient's goals for pregnancy and family planning. Shared decision-making plays a central role. Every situation is different, and treatment choices are shaped by personal values, risk considerations and long-term planning.

Treatment depends on the severity of the condition and how well a patient tolerates the physiologic demands of pregnancy.

Many women with mild or moderate valve disease can continue pregnancy safely with close monitoring. Medications may be used to help manage fluid retention, control heart rate or reduce symptoms.

When valve disease is more severe or symptoms significantly affect daily life, procedures may be done before or during pregnancy. These include:

• Catheter-based procedures to widen a narrow valve or improve function.
• Valve repair to preserve a person's own valve when possible.
• Valve replacement when the disease is advanced or symptoms can't be controlled.

For those who need valve replacement, care teams will discuss the choice between a mechanical or tissue valve, especially for women planning future pregnancies.

• Mechanical valves are durable but require lifelong anticoagulation, which can add complexity during pregnancy.
• Tissue valves typically avoid long-term blood thinners but have a shorter lifespan.

Treatment choices can shape both personal health and a family's future. Clear, collaborative discussions about risks and benefits support confident decision-making.

Expert teams across cardiology, maternal-fetal medicine, imaging and surgery help form a comprehensive plan tailored to each patient's needs.

Any expectant mother should reach out to a clinician if symptoms such as shortness of breath, difficulty breathing when lying flat, chest discomfort, palpitations, swelling that increases rapidly or new fatigue begin to interfere with daily life.

When something doesn't feel right, speaking up is one of the most important steps a patient can take. A strong care team is ready to help navigate each stage of pregnancy to safely support the health of both the patient and the baby.

Katie Young, M.D., Cardio-Obstetrics, Mayo Clinic, Rochester, Minnesota

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