All women with Valvular Heart Disease should ideally have preconception evaluation which includes advice on risk prediction and contraception by a joint cardiac-obstetric team seeking advice from other specialities. In this presentation, Dr Blanche Cupido discusses the causes and epidemiology of valvular heart diseases and talks about various outcome studies. She discusses the high burden of rheumatic heart disease in Africa, the WHO classification and discusses a case study from her own unit, of a 28 year old woman who was treated medically and delivered her baby. Dr Cupido talks about the outcomes in mitral stenosis in the context of the case study. Dr Cupido talks to the sub-Saharan African context and the predictors of adverse outcomes. She also examines the South African context, partularly the KZN and Pretoria group which showed that patients with MS can be treated effectively. Cupido discusses the principles of management for MS and prophylaxis. Cupido then discusses the indications for PTMC and the risks thereof and states that the success rate of >95% with fewer fetal and neonatal deaths, makes PTMC the procedure of choice. Dr Cupido discusses the importance of therapeutic anticoagulation throughout pregnancy and reviews maternal and fetal risks associated with the various regimens. Dr Cupido briefly discusses prosthetic valves and concludes by stating that Aspirin and NOACS are not to be used as sole anticoagulants in pregnancy.