Clinical evaluation of women with VHD who are contemplating pregnancy includes a complete TTE with full anatomic and hemodynamic assessment of the valves.1 5 A con- genital bicuspid or unicuspid aortic valve is often associated with dilation of the aortic sinuses, the ascending aorta, or both. Evaluation of women with a congenitally abnormal aortic valve includes assessment of the aorta before pregnancy because of the risk of further aortic enlargement and aortic dissection during pregnancy.1 5 2. Pre-pregnancy counseling with a cardiologist expe- rienced with managing women with valve disease during pregnancy allows discussion of the risks of pregnancy for the mother and fetus. A complete assessment of functional capacity, severity of valve lesions, status of the LV and RV, and pulmonary CLINICAL STATEMENTS AND GUIDELINES pressures is necessary to determine the risk of pregnancy and delivery. Medications are reviewed to avoid agents that may have potential harmful effects on the fetus. Pre-pregnancy evaluation also allows discussion of options for interventions before pregnancy, such as valve replacement, valve repair, or percutaneous aortic or mitral balloon dilation, particularly in those patients with severe rheumatic MS or AS.1 5 3. Women with severe valve disease who become pregnant are at an elevated risk of cardiac morbid- ity and mortality. Babies born to such mothers are also at risk of serious complications. Identification and management of complications are improved by monitoring in a tertiary-care center with an experienced team of healthcare providers who have expertise in managing high-risk cardiac con- ditions during pregnancy.1 12 4. Patients with severe valve disease may be asymp- tomatic, which can pose a diagnostic and thera- peutic dilemma in women with these disorders who are considering pregnancy. 