Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Adult Congenital Heart Disease Unit, Hospital Vall d'Hebron, Barcelona, Spain
Heart. 2023 Jul 12;109(15):1153-1158. doi: 10.1136/heartjnl-2022-322328.
To describe the aortic-related risks associated with pregnancy in women with bicuspid aortic valve (BAV) and to evaluate changes in aortic diameter in pregnancy.
Prospective observational study of patients with BAV from a single-site registry of pregnant women with structural heart disease between 2013 and 2020. Cardiac, obstetric and neonatal outcomes were studied. An assessment of aortic dimensions was performed during pregnancy by two-dimensional echocardiography. Aortic diameters were measured at the annulus, root, sinotubular junction and maximum ascending aorta diameter, and the largest diameter was used. Measurements of the aorta were made using the end-diastolic leading edge-to-leading edge convention.
Forty-three women (32.9 years, IQR 29.6-35.3) with BAV were included: 9 (20.9%) had repaired aortic coarctation; 23 (53.5%) had moderate or severe aortic valve disease; 5 (11.6%) had a bioprosthetic aortic valve; and 2 (4.7%) had a mechanical prosthetic aortic valve. Twenty (47.0%) were nulliparous. The mean aortic diameter in the first trimester was 38.5 (SD 4.9) mm, and that in the third trimester was 38.4 (SD 4.8) mm. Forty (93.0%) women had an aortic diameter of <45 mm; 3 (7.0%) had 45-50 mm; and none had >50 mm. Three women (6.9%) with BAV presented cardiovascular complications during pregnancy or the postpartum period (two prosthetic thrombosis and one heart failure). No aortic complications were reported. There was a small but significant increase in aortic diameter during pregnancy (third trimester vs first trimester, 0.52 (SD 1.08) mm; p=0.03). Obstetric complications appeared in seven (16.3%) of pregnancies, and there were no maternal deaths. Vaginal non-instrumental delivery was performed in 21 (51.2%) out of 41 cases. There were no neonatal deaths, and the mean newborn weight was 3130 g (95% CI 2652 to 3380).
Pregnancy in BAV women had a low rate of cardiac complications with no aortic complications observed in a small study group. Neither aortic dissection nor need for aortic surgery was reported. A low but significant aortic growth was observed during pregnancy. Although requiring follow-up, the risk of aortic complications in pregnant women with BAV and aortic diameters of <45 mm at baseline is low.
描述二叶式主动脉瓣（BAV）女性妊娠相关的主动脉风险，并评估妊娠期间主动脉直径的变化。
对 2013 年至 2020 年间在结构性心脏病孕妇单中心登记处的 BAV 患者进行前瞻性观察性研究。研究了心脏、产科和新生儿结局。在妊娠期间通过二维超声心动图对主动脉进行评估。在瓣环、根部、窦管交界处和最大升主动脉直径处测量主动脉直径，并使用最大直径。主动脉的测量采用舒张末期前缘到前缘的方法。
共纳入 43 名（32.9 岁，IQR 29.6-35.3）BAV 女性：9 名（20.9%）有修复的主动脉缩窄；23 名（53.5%）有中度或重度主动脉瓣疾病；5 名（11.6%）有生物瓣主动脉瓣；2 名（4.7%）有机械瓣主动脉瓣。20 名（47.0%）为初产妇。第一孕期主动脉直径平均值为 38.5（SD 4.9）mm，第三孕期为 38.4（SD 4.8）mm。40（93.0%）名女性的主动脉直径<45mm；3 名（7.0%）为 45-50mm；无一例>50mm。3 名（6.9%）BAV 女性在妊娠或产后期间出现心血管并发症（2 例人工瓣血栓形成，1 例心力衰竭）。无主动脉并发症报告。妊娠期间主动脉直径有轻微但显著的增加（第三孕期比第一孕期增加 0.52（SD 1.08）mm；p=0.03）。7 例（16.3%）妊娠出现产科并发症，无产妇死亡。41 例中有 21 例（51.2%）行阴道非器械分娩。无新生儿死亡，新生儿平均体重为 3130g（95%CI 2652-3380）。
在这项小型研究中，BAV 女性妊娠的心脏并发症发生率较低，未观察到主动脉并发症。没有发生主动脉夹层或需要主动脉手术。妊娠期间主动脉有轻度但显著的生长。尽管需要随访，但在 BAV 女性和基线时主动脉直径<45mm 的孕妇中，主动脉并发症的风险较低。
