Pregnancy in a Patient With Severe Aortic Stenosis Requiring Unusual Management

Abstract

IN DEVELOPED COUNTRIES, congenital heart disease is the most common cardiovascular disease reported during pregnancy, with the majority of the cases of aortic stenosis in pregnant women being caused by congenital bicuspid aortic valve. While patients with asymptomatic mild, moderate, or even severe aortic stenosis usually can continue pregnancy to term, all symptomatic patients with severe aortic stenosis or asymptomatic patients with impaired left ventricular function are at high risk for cardiac complications. Aortic valve replacement is indicated before pregnancy in these women. Percutaneous aortic valvuloplasty also can be considered during pregnancy. More invasive techniques, such as aortic valve replacement under normothermic cardiopulmonary bypass during pregnancy, are associated with a high risk of mortality and morbidity for both the mother and the fetus The authors report here a case in which the global management of a pregnant patient with severe aortic stenosis was reconsidered in light of an unexpected echocardiographic report of calcified valves with a high risk of emboli.