Enlarged aorta, want to get pregnant

Thank you for answering my question.  I am a 31 year old female with a bicuspid aorta, which I've been aware of my entire life.  I have never noticed any symptoms and I even ran two marathons, in 2004 and 2005, though I've gotten out of shape since then.  I go in every year or so for an echo to monitor the situation.  According to the echos, I have a bicuspid aorta, moderate stenosis and severe regurgitation.

My husband and I would like to start a family and we met with a cardiologist to see what concerns we should be aware of.  She ordered an MRI, which I had never had before, only echos.  Previous to the MRI, she was very encouraging and said that I would certainly be high-risk, but would probably tolerate pregnancy well.  However, the MRI revealved that my mid-ascending aorta is enlarged to 4.4 cm (they could never tell this from the echos I had before).  My cardiologist advised me not to get pregnant under any circumstances because there is a strong risk of the aorta dissecting.  She said it is similar to what they see in patients with Marfan's, who they also discourage from being pregnant.

She did imply that it might possibly be okay to have a child in the future if I have surgery to correct this.  But she seemed very wishy-washy on whether I should have the surgery, at least for the time being.  I am going for another MRI in 6 months and in the meantime I am on 50mg/day of Cozaar.  For now, I am just trying to eat healthy and get cardio exercise (I was told no weight lifting) so that at least I will be in better shape for whatever happens.

Before we had a chance to meet with the cardiologist, I did get pregnant earlier this year and miscarried, and that has just made me feel so desperate to get pregnant again.  Needless to say, this news is rather shocking and devastating, and I am just wondering what is your take on this, if maybe you can offer me a bit more hope in this situation.  Thank you.

[Douglas Bogart, MD]

People with a bicuspid aortic valve do get enlargement of the ascending aorta and do have a small risk of an aortic dissection.   If you have severe regurgitation and moderate aortic stenosis alone I would be worried about pregnancy and you may need surgery on this alone.  This is a difficult problem and I would advise you to go to a large center where they have alot of experience with high risk pregnancies.