Pregnancy and delivery management of women with aorta and aortic valve pathology

Abstract

Aim. To analyze the specifics of clinical course of pregnancy, delivery and postnatal period in women with disorders of aortic valve (AV) and aorta. Material and methods. During the period from January 2012 to December 2014, under conditions of specialized perinatal center of FSBI Almazov Center in Saint- Petersburg, into prospective cohort study, 56 patients included, with structural pathology of aorta and AV. Mean age 29±4,5 y. o. (18-38 y. o.). All patients underwent echocardiographic study (EchoCG) on Vivid 7 GE equipment by standard protocol. The level of N-terminal brain natriuretic peptide (NT-proBNP) was measured by electrochemiluminiscent analyzer Cobas e411 (Roche, Swiss) at 34±6 week of pregnancy. Results. The most common pathology in the analyzed group were aortic stenosis and aortic coarctation. The main cause of AV pathology was inborn defect (IHD) - bicuspid AV (BAV). Complications in cardiovascular functioning developed in 9 cases (16%) and were related to ventricular rhythm disorders of high grades and signs of heart failure with need of medication treatment (10,7%, n=6). Level of NTproBNP was higher than 125 pg/mL in 12 patients (21,4%) and its mean value was 330,3±54,7 pg/mL; in women with increased NT-proBNP complications in cardiovascular system developed 3 times more often. In 25 patients (44,6%) various obstetric complications were found, mostly in the 3rd trimester of pregnancy. Regardless the clinically significant cardial pathology, women delivered in mature term, 38,6±1,5 weeks. After delivery there were no cases of heart failure progression or other cardiovascular complications development. Conclusion. For women with aortic and AV pathology there is benign prognosis of pregnancy and delivery taken they are managed in specialized centers.