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Case Reports
. 2025 Aug 20;15(16):2099.
doi: 10.3390/diagnostics15162099.

Severe Aortic Stenosis and Pre-Excitation Syndrome in Pregnancy-A Multidisciplinary Approach

Miruna Florina Ştefan  1 , Lucia Ştefania Magda  1   2 , Catalin Gabriel Herghelegiu  3 , Doru Herghelegiu  3 , Oana Aurelia Zimnicaru  1 , Catalin Constantin Badiu  1   2 , Maria Claudia Berenice Suran  1   2 , Andreea Elena Velcea  1   2 , Calin Siliste  1   2 , Dragoș Vinereanu  1   2
Affiliations
Case Reports

Severe Aortic Stenosis and Pre-Excitation Syndrome in Pregnancy-A Multidisciplinary Approach

Miruna Florina Ştefan et al. Diagnostics (Basel). .

Abstract

Background/Objectives: Heart disease affects 0.1% to 4% of pregnant women, with congenital heart defects being the leading cause in developed countries. While maternal mortality is generally low, pre-existing cardiac conditions substantially increase adverse outcome risks. This report describes the multidisciplinary management of a pregnant patient with a bicuspid aortic valve, severe aortic stenosis, and ascending aortic ectasia. Case Presentation: A 34-year-old pregnant woman, asymptomatic but at high risk (World Health Organization Class III) for hemodynamic decompensation, was closely monitored throughout gestation. At 36 weeks, intrauterine growth restriction was detected, prompting an elective cesarean delivery at 38 weeks. Postpartum, the patient developed pre-eclampsia, which was managed successfully. Imaging revealed progressive aortic dilation, leading to surgical aortic valve replacement and ascending aorta reduction plasty. Post-operatively, atrioventricular reentrant tachycardia from an unrecognized accessory pathway developed; medical therapy effectively controlled the arrhythmia after failed catheter ablation. One year later, both mother and child remained in good health. Discussion: This case illustrates the complexity of managing pregnancy in women with congenital heart disease and significant aortic pathology. The physiological changes of pregnancy can exacerbate underlying lesions, necessitating individualized risk assessment, vigilant monitoring, and timely intervention. Conclusions: A multidisciplinary approach involving cardiology, obstetrics, anesthesiology, and genetics is essential to optimize outcomes for pregnant women with significant heart disease. As advances in care allow more women with congenital heart defects to reach childbearing age, structured care pathways remain vital for ensuring safe pregnancies and long-term cardiovascular health.

Keywords: aortic stenosis; bicuspid aortic valve; maternal–fetal medicine; pre-eclampsia; pre-excitation syndrome; pregnancy and cardiovascular disease.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Transthoracic Echocardiography at 22 weeks of gestation. Panel (A)—Tricuspid Annular Plane Systolic Excursion (TAPSE) measurement; Panel (B)—Mitral inflow; Panel (C)—Ascending aorta measurement.
Figure 2
Figure 2
Transthoracic Echocardiography at 22 weeks of gestation—hemodynamic parameters and calculation of the aortic valve area (AVA) through the continuity equation. (Left)—Measurements at the level of the Aortic valve (VTI—velocity time index, maximum and mean gradient, maximum and mean velocity); (Right)—Measurements at the level of the left ventricle outflow tract (LVOT) (VTI—velocity time index, maximum and mean gradient, maximum and mean velocity).
Figure 3
Figure 3
Electrocardiograms. Panel (A)—At baseline, before heart surgery; Panel (B)—During atrio-ventricular re-entrant tachycardia; Panel (C)—After conversion to sinus rhythm.
Figure 4
Figure 4
Fetal echography showing no cardiac or aortic malformation. Panel (A)—Normal filling of the heart chambers; Panel (B)—Normal origin of the aorta, no stenosis; Panel (C)—Sagittal view showing a normal aorta, no coarctation.
Figure 5
Figure 5
Echo-graphic signs of intrauterine growth restriction. Panel (A)—Growth chart showing the flattening of the fetal growth curves; Panel (B)—Doppler ultrasound showing decreased resistance and pulsatility in the middle cerebral artery; Panel (C)—Doppler ultrasound showing increased resistance and pulsatility in the umbilical artery.
Figure 6
Figure 6
Aortic computed tomography. Panel (A)—Measurements of the aortic lumen; Panel (B)—Digital reconstruction of the aorta; Panel (C)—Transverse section at the level of the ascending aorta.
Figure 7
Figure 7
Echocardiography after surgery. Panel (A)—Aortic valve velocities; Panel (B)—Mitral valve inflow; Panel (C)—Ascending aorta measurement.
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References

    1. Regitz-Zagrosek V., Roos-Hesselink J.W., Bauersachs J., Blomström-Lundqvist C., Cífková R., De Bonis M., Iung B., Johnson M.R., Kintscher U., Kranke P., et al. 2018 ESC Guidelines for the Management of Cardiovascular Diseases during Pregnancy. Eur. Heart J. 2018;39:3165–3241. doi: 10.1093/eurheartj/ehy340. - DOI - PubMed
    1. Roos-Hesselink J.W., Ruys T.P.E., Stein J.I., Thilén U., Webb G.D., Niwa K., Kaemmerer H., Baumgartner H., Budts W., Maggioni A.P., et al. Outcome of Pregnancy in Patients with Structural or Ischaemic Heart Disease: Results of a Registry of the European Society of Cardiology. Eur. Heart J. 2013;34:657–665. doi: 10.1093/eurheartj/ehs270. - DOI - PubMed
    1. Siu S.C., Silversides C.K. Bicuspid Aortic Valve Disease. J. Am. Coll. Cardiol. 2010;55:2789–2800. doi: 10.1016/j.jacc.2009.12.068. - DOI - PubMed
    1. Yap S.-C., Drenthen W., Pieper P.G., Moons P., Mulder B.J.M., Mostert B., Vliegen H.W., van Dijk A.P.J., Meijboom F.J., Steegers E.A.P., et al. Risk of Complications during Pregnancy in Women with Congenital Aortic Stenosis. Int. J. Cardiol. 2008;126:240–246. doi: 10.1016/j.ijcard.2007.03.134. - DOI - PubMed
    1. McKellar S.H., MacDonald R.J., Michelena H.I., Connolly H.M., Sundt T.M., III Frequency of Cardiovascular Events in Women with a Congenitally Bicuspid Aortic Valve in a Single Community and Effect of Pregnancy on Events. Am. J. Cardiol. 2011;107:96–99. doi: 10.1016/j.amjcard.2010.08.061. - DOI - PubMed

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