Bicuspid aortic valve in pregnancy

OBJECTIVE The outcomes in pregnant patients with bicuspid aortic valves (BAVs) are rarely reported, despite the potentially critical nature of the condition. The aim of this study is to present the clinical complications of BAV in pregnancy. MATERIALS AND METHODS A MEDLINE database search and a Google internet search were conducted to find literature on BAV in pregnancy published between 1980 and 2012. RESULTS BAV in pregnancy can lead to critical cardiovascular events including aortic dissection, aortic valve disorders, and infective endocarditis; some of these complications may lead to poor maternal outcomes or fetal demise. No differences were noted in either maternal or fetal mortality between syndromic and nonsyndromic pregnant patients with BAV (maternal: 50% vs. 28.6%; p = 0.4959; fetal: 25% vs. 0%; p = 0.1987). The peak and mean pressure gradients across the aortic valve increased significantly with advancing gestational trimester; a remarkable decrease in peak pressure gradients was seen postpartum. The calculated aortic valve area showed a significant decrease in the third trimester compared with the prepregnancy value, as well as a considerable postpartum decrease. CONCLUSION Syndromic and nonsyndromic BAVs may have similar importance for maternal and fetal mortality. Aortic valve stenosis may become more severe with advancing pregnancy, with attenuation after delivery. Patients may require surgical intervention for the complications of BAV during pregnancy.