Emergency aortic valve replacement and Caesarian section in a primigravida with severe aortic stenosis: a case report.
BACKGROUND
Congenital bicuspid aortic valve with severe aortic stenosis (AS) is a rare condition (3-6% of patients with congenital heart disease). Pregnancy in these patients carries a high risk of maternal and fetal mortality. With advancing gestational age, these women may develop cardiac failure due to increased cardiorespiratory requirements. When medical therapy proves insufficient, cardiac surgery becomes mandatory to save the patient's life. Balloon valvuloplasty is only palliative treatment, the duration of benefit being only 6 months. Valve replacement is thus recommended. Cardiopulmonary bypass (CPB) surgery with valve replacement has been reported to carry a lower risk of maternal mortality (1.5-13%) but a very high fetal risk (16-40%). This paper reports the case of a 30-year-old primigravida with severe AS with bicuspid aortic valve and pulmonary congestion clinically uncontrolled, in whom CPB surgery and aortic valve replacement was performed as an emergency procedure, along with a lower segment Caesarian section.


CONCLUSIONS
The outcome of unrelieved severe symptomatic AS in pregnancy is poor. Multidisciplinary management is important to avoid deterioration in cardiac performance in parturients with severe AS. CPB during pregnancy carries a high risk to the fetus. Therefore, open heart surgery during pregnancy should be advised only in extreme emergencies (ie, heart failure refractory to conventional therapy).
Department of Obstetrics and Gynaecology, Lok Nayak Hospital and MAM College, New Delhi, India.
Puneet K
PK
Kochhar
Department of Obstetrics and Gynaecology, Lok Nayak Hospital and MAM College, New Delhi, India.
V
V
Zutshi
Department of Obstetrics and Gynaecology, Lok Nayak Hospital and MAM College, New Delhi, India.
S
S
Shamsunder
Department of Obstetrics and Gynaecology, Lok Nayak Hospital and MAM College, New Delhi, India.
S
S
Batra
Department of Obstetrics and Gynaecology, Lok Nayak Hospital and MAM College, New Delhi, India.
P
P
Ghosh
Aortic stenosis; Bicuspid aortic valve; cardiopulmonary by-pass in pregnancy; obstetrics; pregnancy; pregnancy with heart disease; severe aortic stenosis; surgery valve; valve replacement