Valve-in-Valve Transcatheter Aortic Valve Replacement for Bioprosthetic Aortic Valve Disease in Pregnancy.

BACKGROUND

Management of valvular disease in pregnancy is complex. Hemodynamic changes associated with pregnancy may exacerbate underlying disease.

CASE SUMMARY: A 32-year-old woman with a history of remote bioprosthetic aortic valve replacement (AVR) presented to care in early pregnancy with progressive dyspnea on exertion. Examination and an echocardiogram revealed moderate to severe bioprosthetic aortic stenosis and severe aortic insufficiency. The patient underwent valve-in-valve transcatheter AVR in the second trimester as a bridge to an uncomplicated term vaginal delivery. She was discharged on postpartum day 2.

DISCUSSION: Structural valve degeneration may be accelerated in pregnancy. Although regurgitant lesions are generally well tolerated, mixed aortic valve lesions may represent a higher-risk phenotype exacerbated by hemodynamic changes of pregnancy and may require intervention.

TAKE HOME MESSAGE: A multidisciplinary cardio-obstetrics team is essential to manage patients with severe, symptomatic valvular heart disease effectively during pregnancy.