Risk of Pregnancy in Aortic Stenosis
What are maternal and fetal outcomes among patients with aortic stenosis (AS)?
The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective, observational registry of women with structural heart disease providing a uniquely large study population. Data on women with moderate (peak gradient 36-63 mm Hg) and severe (peak gradient ≥64 mm Hg) AS were analyzed.
Of 2,966 pregnancies in the ROPAC, 96 women with at least moderate AS were identified (34 with severe AS). Before pregnancy, 36 patients (38%) were symptomatic (32 [33%] class II, 4 [4%] class III). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women were hospitalized for cardiac reasons during pregnancy. This was significantly more common in patients with severe AS compared with moderate AS (35.3% vs. 12.9%, p = 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed medically in all but one patient who was symptomatic prior to pregnancy and underwent balloon valvotomy. Children of patients with severe AS had a significantly higher percentage of low birth weight compared to patients with moderate AS (35.0% vs. 6.0%, p = 0.006).
In the current era, mortality in pregnant women with AS, including those with severe AS, appears to be close to zero. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with high rates of hospitalization for cardiac reasons, although heart failure nearly always can be managed medically.
These data suggest that patients with moderate and probably severe AS can tolerate pregnancy with a relatively low risk of morbid and mortal events. That 38% of patients had symptomatic AS (and therefore an indication for aortic valve intervention) prior to pregnancy reinforces the importance of appropriate preconception patient evaluation and counseling.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Valvular Heart Disease, Congenital Heart Disease, CHD and Pediatrics and Quality Improvement, Acute Heart Failure
Keywords: Aortic Valve Stenosis, Balloon Valvuloplasty, Counseling, Heart Defects, Congenital, Heart Failure, Heart Valve Diseases, Infant, Low Birth Weight, Mortality, Pregnancy, Risk
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