Multidisciplinary Approach of Management for Obstetric Patient With Moderate to Severe Bicuspid Aortic Valve Stenosis: A Case Report

Bicuspid aortic valve stenosis presents unique challenges during pregnancy due to increased hemodynamic stress and the potential for cardiovascular collapse. Therefore, a multidisciplinary approach is essential to optimize maternal and neonatal outcomes. This case report explores the complex management of a pregnant patient with bicuspid aortic valve stenosis who declined termination. A 20-year-old female at 17 weeks of gestation presented with progressive shortness of breath on exertion and fatigue. Serial transthoracic echocardiography (TTE) revealed a mean aortic valve gradient of 46 mmHg and an aortic valve area of 0.9 cm², indicating severe aortic stenosis. At 35 weeks of gestation, the patient developed syncope and shortness of breath at rest with a metabolic equivalents (METS) score <4, requiring hospital admission. At 37 weeks, a planned cesarean section was performed, with extracorporeal membrane oxygenation (ECMO) cannulas inserted prior to induction as a standby. The anesthetic technique included invasive monitoring and induction with midazolam, lidocaine, fentanyl, etomidate, and rocuronium, with maintenance using remifentanil infusion and sevoflurane. The baby was delivered within five minutes in good health, and the patient was transferred to the ICU for close observation. Pregnancy poses considerable risks for patients with severe aortic stenosis, as physiological changes can precipitate cardiac decompensation. Successful management relies on meticulous planning, individualized care, and interdisciplinary collaboration, with anesthetic strategies focused on maintaining maternal hemodynamic stability while ensuring fetal well-being. This case highlights the importance of a multidisciplinary approach and tailored anesthetic and perioperative management to achieve favorable maternal and neonatal outcomes in patients with severe aortic stenosis.