Valvular Heart Disease and Pregnancy

Management of aortic stenosis in pregnancy

“…(2)(3)(4)(5) Rheumatic AS is another important cause, especially in developing countries. (6) The majority of rheumatic AS is accompanied by rheumatic mitral valve involvement, although rare cases of isolated rheumatic AS have been seen.…”

“…The degree of dilation does not correlate with the severity of the AS, some patients with only mild AS have severe aortic root dilatation. (5) The theory of post stenotic dilatation has largely been abandoned. An aortic root measurement at any level of more than 50mm is associated with a marked increase in the risk of aortic dissection and surgery prior to conception should be advocated.…”

“…Thus the ability to predict the haemodynamic impact of pregnancy on AS is simpler than in patients with MS and offers fewer surprises during pregnancy. (5) Most patients with mild and moderate AS with normal left ventricular ejection fraction (LVEF) and aortic root diameter have a favorable outcome with pregnancy. (3,5,8) Symptoms and exercise testing predict the maternal risk with severe AS.…”

“…(5) Most patients with mild and moderate AS with normal left ventricular ejection fraction (LVEF) and aortic root diameter have a favorable outcome with pregnancy. (3,5,8) Symptoms and exercise testing predict the maternal risk with severe AS. Patients who are asymptomatic and remain asymptomatic during exercise stress testing should be able to sustain pregnancy with limited maternal risk.…”

“…The absolute risk of dissection is difficult to estimate, but currently a diameter of less than 45mm is considered safe to proceed with pregnancy (risk of dissection equal to the general population). (5) Patients with severe AS who are asymptomatic should tolerate pregnancy provided:…”