We read with interest the paper by Bhagra et al 1 and wish to add further information from two recent publications which emphasise their key points that ‘pregnancy in women with mechanical heart valves is high risk’ and that ‘a multidisciplinary team approach to the management of pregnant women with Prosthetic Heart Valves is necessary to ensure optimal outcomes.’ A recent prospective observational national study of women in the UK with pregnancies between February 2013 and January 2015,...