Patients with valvular heart disease represent not frequent but highly specific problem in pregnancy. They require interdisciplinar approach of a cardiologist, a gynecologist- obstetrician and an anesthetist. Valvular heart lesions associated with high maternal and / or fetal risk during pregnancy are severe aortic stenosis, mitral stenosis with NYHA class II-IV symptoms, regurgitant aortic / mitral valve diseases with NYHA class III-IV symptoms, valve diseases with severe left ventricular dysfunction (LVEF < 40 %) or with severe pulmonary hypertension, Marfan syndrome with aortic regurgitation and mechanical prosthetic valves requiring anticoagulant therapy. Because of the possible risk of maternal and fetal morbidity and mortality associated with pregnancy and delivery, it is important to emphasize the planned pregnancy after thorough discussion with the woman and her partner and after cardiologic evaluation and consideration for invasive treatment especially of severe stenotic lesions before conception. Anticoagulant therapy in pregnant women with mechanical prosthetic valves differs from the usual treatment. There is no consensus regarding treatment during the first trimester.