Transcatheter Aortic Valve Replacement During Pregnancy
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Transcatheter aortic valve replacement (TAVR) is an approved and widely accepted standard treatment for severe symptomatic aortic stenosis (AS) in high-risk surgical candidates.1 Severe symptomatic AS during pregnancy presents a difficult clinical challenge.2 A 22-year-old female patient presented to our service at 15 weeks’ gestation with congenital symptomatic AS. After a thoughtful heart team evaluation, TAVR was recommended to the patient and performed at 22 weeks’ gestation. The authors further explore and discuss the preprocedure planning and treatment decisions of this case. The heart team focused on the timing and special considerations needed to ensure the health and safety of the patient and fetus. With careful preprocedural planning, TAVR can be a low-risk treatment option during pregnancy and provide a reliable bridge to a healthy, term delivery.
A 22-year-old pregnant female patient presented with severe symptomatic AS at 15 weeks’ gestation. The patient was 165 cm tall, weighed 74 kg with a body mass index of 27 kg/m2 and body surface area of 1.84 m2 at the time of presentation. The patient’s clinical history includes congenital bicuspid aortic valve disease, which required balloon aortic valvuloplasty (BAV) at the age of 9 years. Throughout young adulthood, she had been asymptomatic with high levels of activity. Her chief complaints on presentation were increased dizziness, dyspnea on exertion, and chest discomfort. Echocardiography demonstrated a normal ejection fraction, an aortic peak flow velocity of 4.04 m/s, an aortic valve mean gradient of 38.22 mm Hg, an aortic valve area of 1.0 cm2, and mild-to-moderate aortic insufficiency (AI). The ascending aorta was mildly enlarged (3.9 cm). There was mild narrowing of periductal isthmus with no Doppler gradient (Figure 1; Table 1). Stress echocardiography testing showed moderate AI and below-average exercise capacity. The patient completed 8 to 9 metabolic equivalents …