Congenital aortic valve stenosis with very high pressure gradient in a pregnant patient

Methods: A 34-year-old woman was in her 24th week of her second pregnancy when she suffered a recurrence of her congenital aortic valve stenosis (CAS), previously treated by surgical commissurotomy. She was dyspneic on only mild exertion. The first pregnancy had been uneventful. Methods: RR was 110/70 mmHg. The electrocardiogram showed left ventricular hypertrophy and myocardial damage. Echocardiography revealed a maximal systolic gradient of 155 mm Hg (mean gradient 104 mm Hg). The blood picture showed a pregnancy-related mild anemia and haemodilution. Methods: The patient was hospitalized as a precaution from the 31st week of pregnancy onwards. An elective section was performed under intubation aneasthesia in the 36th week of pregnancy. The aortic valve was electively replaced 13 weeks after delivery.

Conclusions: Patients with a CAS who had been treated palliatively with a commissurotomy should be carefully and regularly monitored to avoid recurrent stenosis. Close collaboration with the delivery team is essential.