[Dr.Vad]

По поводу порока: стеноз не малый (менее 1,5 см2), но и не слишком (менее 1 см2), чтобы была необходимость в хир. вмешательстве. Основные рекомендации: избегать физ. нагрузок, контроль за водным балансом и потреблением соли, при перегрузке - мочегонные, при тахикардии - бета-блокаторы. Подробнее можете ознакомиться в отрывке из недавнего обзора:

Mitral Stenosis

Rheumatic mitral stenosis is the most common clinically significant valvular abnormality in pregnant women and may be associated with pulmonary congestion, edema, and atrial arrhythmias during pregnancy or soon after delivery. The increased volume load and increased cardiac output associated with pregnancy lead to an increase in left atrial volume and pressure, elevated pulmonary venous filling pressures, dyspnea, and decreased exercise tolerance. Increases in the maternal heart rate decrease the diastolic filling period, further increasing left atrial pressure. Mortality among pregnant women with minimal symptoms is less than 1 percent. In a study of women with mitral stenosis, predictors of adverse maternal outcomes included a reduced mitral-valve area (less than 1.5 cm2) and an abnormal functional class before pregnancy. Fetal mortality increases with deteriorating maternal functional capacity; fetal mortality is 30 percent when there is NYHA class IV disease in the mother.

For women with mild or moderate symptoms during pregnancy, medical therapy is directed at the treatment of volume overload and includes diuretic therapy, the avoidance of excessive salt, and the reduction of physical activity. Beta-blockers attenuate the increases in heart rate and prolong the diastolic filling period, which provides symptomatic benefit. Development of atrial fibrillation requires prompt treatment, including cardioversion. Beta-blockers and digoxin are used for rate control. If suppressive antiarrhythmic therapy is needed, procainamide and quinidine are the drugs with which we have the most extensive experience. Because of the increased risk of systemic embolism in patients with mitral stenosis and atrial fibrillation, anticoagulant therapy is indicated.

Patients with severe symptoms (NYHA class III or IV) or tight mitral stenosis (a valve area of less than 1.0 cm2) who undergo balloon mitral valvuloplasty or valve surgery before conceiving appear to tolerate pregnancy with fewer complications than similar women who are treated medically. In patients who present with severe symptoms during pregnancy, successful percutaneous balloon mitral valvuloplasty, performed during the second trimester, has been associated with normal subsequent deliveries and excellent fetal outcomes. Risks to the fetus associated with exposure to radiation may be reduced by avoiding exposure to radiation during the first half of pregnancy. Pregnant women who are to be exposed to radiation should have the uterus shielded and should be informed about the possible risks. Mitral valvuloplasty has also been performed under transesophageal echocardiographic guidance, eliminating these risks. Open cardiac surgery has been performed during pregnancy for severe mitral stenosis. Maternal outcomes are approximately the same as those among nonpregnant patients, but there is fetal loss in 10 to 30 percent of cases.

Vaginal delivery is the usual approach, with the use of epidural anesthesia to achieve effective pain control and with the use of assisted-delivery devices during the second stage of delivery (eliminating the need for pushing). Cesarean section should be performed when there are obstetrical indications for it. Labor is associated with an increase of 8 to 10 mm Hg in the left atrial and pulmonary wedge pressures. Pulmonary arterial catheters have been used successfully before and during delivery to facilitate the management of hemodynamics in women with advanced disease.

Из N Engl J Med. 2003 Jul 3;349(1):52-9.
Clinical practice. Valvular heart disease in pregnancy.
Reimold SC, Rutherford JD.