In asymptomatic women with severe AS (aortic velocity 4.0 m/s or mean pressure gradient 40 mmHg, Stage C1) who are considering pregnancy, do not meet COR 1 criteria for intervention, and have a preconception evaluation confirming the absence of symptoms (including normal exercise stress testing and serum BNP measurements), medical management during pregnancy may be considered to avoid prosthetic valve replacement. In asymptomatic women with severe MR (Stage C1) and a valve suitable for repair who are considering pregnancy, valve repair before pregnancy at a Comprehensive Valve Center may be considered but only after detailed discussion with the patient about the risks and benefits of the surgery and its effect on future pregnancies. Synopsis In women with severe VHD who are considering preg- nancy, the indications for considering intervention in- clude the presence of symptoms, asymptomatic severe AS, asymptomatic severe MR with a repairable valve, and asymptomatic severe rheumatic MS with a valve morphol- ogy suitable for PMBC. If a prosthetic valve is needed, the shared decision-making process about the choice of type of prosthetic valve should include discussion of the risks of valve thrombosis and adverse effects from anticoagula- tion with mechanical valves versus the reduced durability of bioprosthetic valves in young women (Figure 17). Recommendation-Specific Supportive Text 1. Standard indications for intervention in symptom- atic patients with severe valve disease also apply to women who are considering pregnancy.1 11 2. Women of childbearing age who require valve intervention have important choices to make about the risks and benefits of the types of pros- thetic valves. The risks to the mother and fetus of valve thrombosis and anticoagulation dur- ing pregnancy with a mechanical valve must be weighed against the reduced durability of bio- prosthetic valves in young women. 