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Sibel Catirli Enar

Sibel Catirli Enar

Memorial ÅžiÅŸli Hospital, Turkey

Title: Aortic valve diseases in pregnancy

Biography

Biography: Sibel Catirli Enar

Abstract

Background: Stenotic rheumatic aortic valve diseases carry a higher risk in pregnancy. Regurgitant lesions are usually better tolerated. Mechanical valve prosthesis carry the risk of valve thrombosis and bleeding complications.Tissue valve prosthesis avoid the use of anticoagulants and thus, the complications.However,they are associated with higher risk of degeneration. According to ROPAC (The registry on pregnancy and cardiac disease), symptomatic and severe aortic stenosis carry a risk of heart failure and is associated with high rates of hospitalization for cardiac reasons. We report three cases: aortic mechanical valve, aortic homograft valve and severe aortic regurgitation in pregnancy.
Cases: Case 1 is a 30 years old female. She had undergone AVR due to rheumatic valvular disease.Valve thrombus occured in the first trimester and was successfuly resolved with tpa. Delivery was done with Ceaserean section (SC). There was some increase in her mitral regurgitation after the delivery. Baby had low birth weight,but no other complications occured.
Case 2 is a 25 years old female who had aortic homograft valve replacement for her bicuspid aortic valve. First pregnacy was uneventful.In her second pregnancy, aortic regurgitation was present and delivery was done with SC.She was treated medically. Case 3 is a 30 years old female who had rheumatic moderate aortic regurgitattion.During pregnancy, aortic regurgitation increased, and delivery was done with CS. After the delivery, aortic regurgitation decreased. No complications occurred with the baby.
Conclusion: Careful management of aortic valve diseases during pregnancy reduces complications. Even patients with  mechanical prosthetic valves may be successfully treated. Mortality in pregnant women with aortic stenosis is very low. However,these patients carry a risk of heart failure which can be managed medically. Appropriate pre-conceptional patient evaluation and counseling is important in these patients.

Recent Publications:

  1. van Hagen IM, Roos-Hessenlink JW, Donvito V et al.(2017). Incidence and predictors of obstetric and fetal complications in women with structural heart disease. Heart 2017.
  2. Bons LR, Roos-Hesselink JW.(2016). Aortic disease and pregnancy. Curr Opin Cardiol.2016 Nov; 31(6):611-617.
  3. Orwat S, Diller GP, van Hagen IM et al.(2016).Risk of pregnancy in moderate and severe aortic stenosis: From the multinational ROPAC registry. J Am Coll Cardiol 2016 Oct 18; 68(16):1727-37.
  4. Sliwa K, Johnson MR, Zilla P, Roos-Hesselink JW.(2015).Management of valvular disease in pregnancy: A global perspective.(2015). Eur Heart J.2015 May 7; 36(18):1078-89.
  5. Carboni S, Capucci R, Pivato E et al.(2013). Marfan’s syndrome and pregnancy: A good maternal and fetal outcome. J Prenat Med.2013Apr; 7(2):21-4.
  6. De Santo LS, Romano G, della corte A et al.(2012).mechanical aortic valve replacement in young women planning on pregnancy:  Maternal and fetal outcomes under low oral anticoagulation, a pilot observational study on a comprehensive pre-operative counselling protocol. J Am Coll Cardiol 2012 Mar 20; 59(12):1110-5.