Congenital Aortic Stenosis in Adults: Update on clinical outcome, diagnostic methods and pregnancy

Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve replacement is limited. Methods: Using a nationwide Dutch registry (CONCOR) and a local Belgian tertiary care centre database, 17 women (age range: 18-45 years) with pulmonary autograft valve replacement were enrolled into the study. Twelve pregnancies were observed among five different women, including one miscarriage and one elective abortion. Results: Clinically significant (non-)cardiac complications were documented in two of 10 completed pregnancies. Complications included: (I) placental abruption necessitating Cesarean delivery at 29 weeks’ gestation, further complicated by postpartum hemorrhage; and (II) preterm premature rupture of the membranes resulting in premature delivery at 29 weeks’ gestation with postpartum demise of the immature born child. Two women reported primary female infertility, but both became pregnant after hormonal substitution therapy. Four women reported irregularities of their natural menstrual cycle (menorrhagia, dysmenorrhea, polymenorrhea, oligomenorrhea, or amenorrhea). Conclusions: Successful pregnancy in women with pulmonary autograft valve replacement is possible, although serious and clinically significant events occurred during gestation. Infertility and menstrual cycle disorders appear to be more prevalent.

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