Most patients with asymp- tomatic severe MR tolerate the hemodynamic changes of pregnancy, and there is no evidence for acceleration of LV dysfunction during preg- nancy. High-risk features for development of HF during pregnancy in women with MR include depressed LV systolic function and pulmonary hypertension (pulmonary artery systolic pressure >50 mm Hg). In high-risk asymptomatic women with severe MR, referral to a Comprehensive Valve Center allows consideration of mitral valve morphology, the likelihood of a successful valve repair, and estimated surgical risk in the Figure 17. Preconception management of women with native valve disease. Colors correspond to Table 2. TTE indicates transthoracic echocardiography; and VHD, valvular heart disease. CLINICAL STATEMENTS AND GUIDELINES 13.1.2.2. During-Pregnancy Intervention Recommendations for Intervention During Pregnancy in Women With VHD Referenced studies that support the recommendations are summarized in Online Data Supplement 43. 