Outcome of pregnancy in patients with bicuspid aortic valve – a study of 89 patients (RCD code: VII-IV-1D.2o)

Agata Leśniak-Sobelga, Magdalena Kostkiewicz, Sylwia Wiśniowska-Śmiałek, Paweł Rubiś, Piotr Podolec

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Abstract


The changes in hemodynamics, as well as changes in the aortic media during pregnancy, put the women with bicuspid aortic valve (BAV) and significant aortic stenosis (AS) and/or dilated aortic roots at risk for complications during this period. From 1988–2014,89 pregnant patients with BAV, mean 26.8 ±4.6 years, were observed. There were 52 patients with AS: 22 with mild AS, 30 with moderate to severe AS and 37 patients with aortic insufficiency (AI). Medical history, physical examination, NYHA class assessment, ECG and echocardiography were performed during each trimester (TR) of pregnancy and after delivery. During pregnancy all patients with mild AS remained in NYHA class I. All of them delivered vaginally healthy babies on term. Patients with moderate to severe AS in I TR remained in NYHA class I-II, in 6/30 patients clinical deterioration was observed within III TR. Seventeen women with severe AS delivered by cesarean section, the remaining vaginally. In the group of IA clinical deterioration was observed in III TR in 5/37 patients with severe AI, enlarged left ventricle (LV) and depressed systolic function. Six of them delivered by cesarean section, the remaining vaginally. Conclusions: Patients with mild AS tolerate well the increased cardiovascular demand of pregnancy. In patients with severe AS pregnancy intensifies the hemodynamic disorders. Volume overload of pregnancy is well tolerated in patients with mild and moderate IA. Cardiac complications can be expected in patients with severe IA, LV enlargement and impaired systolic function. In the observed group of BAV patients there was no pregnancy-associated dissection. JRCD 2014; 2 (1): 9–14

Keywords


bicuspid aortic valve, aortic stenosis, aortic insufficiency, pregnancy, dissection

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DOI: http://dx.doi.org/10.20418%2Fjrcd.vol2no1.154

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