Pregnancy in women with a bicuspid aortic valve
- Carol A Waksmonski, MD
Carol A Waksmonski, MD
- Professor of Medicine
- Columbia University Medical Center
- Michael R Foley, MD
Michael R Foley, MD
- University of Arizona College of Medicine - Phoenix
- Section Editors
- Heidi M Connolly, MD, FASE
Heidi M Connolly, MD, FASE
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
A bicuspid aortic valve has been estimated to occur in approximately 2 percent of the general population [1,2] with a 4:1 male predominance . A bicuspid aortic valve may be functionally normal or it may be stenotic and/or regurgitant. Bicuspid aortic valve is the most common cause of isolated valvular aortic stenosis (AS) in adults and the most common cause of isolated aortic regurgitation (AR). Dilation of the ascending aorta is likely to coexist independent of valvular function [2,3]. (See "Clinical manifestations and diagnosis of bicuspid aortic valve in adults" and "Clinical manifestations and diagnosis of chronic aortic regurgitation in adults".)
Pregnancy in women with a bicuspid aortic valve will be reviewed here. Issues related to management of bicuspid AS and AR and general principles of congenital heart disease in pregnancy are discussed separately. (See "Management of adults with bicuspid aortic valve disease" and "Natural history and management of chronic aortic regurgitation in adults" and "Pregnancy in women with congenital heart disease: General principles".)
A bicuspid aortic valve is generally detected by echocardiography performed to evaluate the murmur of aortic stenosis (AS) and/or aortic regurgitation (AR) or an ejection click. An isolated, functionally normal bicuspid aortic valve is likely to go unrecognized in women of child-bearing age because auscultatory signs are inconspicuous or unrecognized . Rarely, a bicuspid aortic valve is first identified during pregnancy because of dissection of the ascending aorta . (See "Clinical manifestations and diagnosis of bicuspid aortic valve in adults" and 'Aortic aneurysm and risk of aortic dissection' below.)
Women with a bicuspid aortic valve should be counseled regarding potential risks and treatment prior to and during pregnancy. Potential risks that should be discussed include heritable congenital heart disease, aortic enlargement or dissection, and complications of aortic stenosis (AS) and/or aortic regurgitation (AR).
The specific role of counseling in women with aortic dilation is discussed below (see 'Counseling on aortic dilatation' below).
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- AORTIC ANEURYSM AND RISK OF AORTIC DISSECTION
- Aortic imaging
- Counseling on aortic dilatation
- Management of aortic dilatation
- BICUSPID AORTIC STENOSIS
- Clinical significance
- AS treatment prior to pregnancy
- AS treatment during pregnancy
- BICUSPID AORTIC REGURGITATION
- AR treatment prior to pregnancy
- AR treatment during pregnancy
- SURGERY PRIOR TO OR DURING PREGNANCY
- Choice of valve procedure
- Mode of delivery
- Endocarditis prophylaxis
- SUMMARY AND RECOMMENDATIONS