1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.3. 20 minutes
2. Step 10
2.1. Management (for the individual)
2.1.1. Initial
2.1.1.1. anticoaugulant therapy to nprevent thombi due to atrial fibrilation (AF)
2.1.1.2. beta blockers or calcium channel blockers and digoxin for AF
2.1.1.3. low dose of diuretics for congestion (furosomide)
2.1.1.4. salt intake restriction
2.1.1.5. oxygen thrapy
2.1.2. surgical
2.1.2.1. valve repair
2.1.2.2. valve replacment
2.1.2.2.1. biologival VS mechanical
2.1.2.2.2. depends on patients wishes an comorbids
2.1.2.3. balloon vavlvuplasty
2.1.2.3.1. through femoral vein
2.1.2.3.2. contraindicated in calcification
2.1.2.3.3. first line
2.1.2.3.4. prefered in second or third trimester
2.1.2.3.5. performed after assessing of stenosis and calcifaction with echo
2.1.2.3.6. success rate 95 percent against valve repair with less fetal mortality
2.1.2.3.7. have risk of damaging other heart stucture
2.1.2.4. closed vavltomy
2.1.2.5. open valvtomy
2.1.3. GOALS: reduce symptoms, control atrial fibrillation, insuring normal pregnancy and prevent complications
2.2. Prevention (for the population)
2.2.1. primary
2.2.1.1. for 5 years or 21y (which ever is longer)
2.2.2. secondary
2.2.2.1. penicillin for streptococcal infection
2.2.2.2. for 10 years or 21y (which ever is longer)
2.2.2.3. in valvular involvement for 10 years or 40y (which ever is longer)
2.2.3. diet modification (salt intake)
2.2.4. proper follow up after surgery (6-12w)