aortic stenosis: pregnancy and valve replacement

[Shari-Mac]

  I am 30 years old, recently married, diagnosed at birth with aortic stenosis. I have been advised by my doctor that there is a 50+% chance that I will need aortic vaalve replacement in the future. Some bloackage is occurring already. I'd like to research my condition, the risks, etc., but am not sure where to start. Can you point me to some good websites, resources? I am particularly interested in the risks, survival rate of the surgery, as well as complications, risks related to pregnancy. I am not pregnant now, and would prefer not to become so in the next year or two, but got the impression from my doctor that time is running out, and that pregnancy could be dangerous for me in the future.

[CCF Cardio MD - MTR]

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Dear Shari, thank you for your question. It sounds like your aortic stenosis
(AS) has progressed and that you are trying to manage getting pregnant with
an expected aortic valve replacement sometime in the future.  I have searched
the medical literature and textbooks to find some information for you.  First,
I'll provide some references for medical articles that you could obtain at
any medical library.  These detail pregnancy and congenital heart disease.
1) Oakley, CM.  Current Opinions in Cardiology. Vol. 11 pages 155-159. 3/96.
2) Oakley, CM.  Heart.  Vol 78: pages 12-14.  7/97.
3) Lao, TT.  Amer. Journal of Obstetrics and Gynecology. Vol. 169 pages 540-545.
I couldn't find any websites to refer you to.  There may also be some textbooks
on pregnancy and congenital heart disease, but I was unable to find any titles.
With pregnancy, the maternal blood volume increases by 50% and the maternal
cardiac output must increase to compensate for the increased metabolic and
hemodynamic demands of the fetus.  With a fixed obstruction to cardiac output
with aortic stenosis, pregnant mothers could have difficulties with carrying the
pregnancy to term.  Additionally, fetal congenital heart defects can be found
in the fetus so fetal echocardiography (ultrasound of the heart) should be
done at 20 weeks.  Aortic valve replacement can be done before pregnancy but
if a mechanical valve is used and anticoagulatin is required, there could be
potential problems for the fetus.  In a large case series of pregnacies involving
women with AS, maternal and fetal mortality were low and the authors concluded
that pregnancy can be successufully managed in patients with AS.  However,
before becoming pregnant, it would be advisable for you to see a cardiologist
who specializes in congenital heart disease and an obstetrician who specializes
in high-risk deliveries.  Overall, the decision on how to approach your AS and
pregancy rests with you and your cardiologist and you should speak to him after
you learn more about this problem.  Good luck with finding more educational
material.  I hope you find this information useful.
Information provided in the heart forum is for general purposes only.  Specific
diagnoses and therapies can only be provided by your physician.