EFFECT OF PREGNANCY ON THE PROGRESSION OF AORTIC DILATION AND AORTIC VALVE DISEASE IN PATIENTS WITH BICUSPID AORTIC VALVE
CCC ePoster Library. Michelle Fortin L. 10/26/19; 280309; 251
Laurence Brunet et Michelle Fortin
Laurence Brunet et  Michelle Fortin
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Abstract
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BACKGROUND: Pregnancy in women with bicuspid aortic valves (BAV) is considered at risk as it might have an impact on mother and child health. However, no studies have clearly established the effect of pregnancy on the evolution of the BAV disease (aortic dilatation and valve dysfunction). The aim of this study was to compare the evolution of BAV disease in women who underwent at least one pregnancy versus women without any pregnancy.

METHODS AND RESULTS: This is a retrospective cohort study where 34 women with a confirmed BAV were frequency matched. 18 of them never underwent any pregnancy (non-pregnant group: NP) and 16 had at least one pregnancy (pregnancy group: P). Patients were followed with several echocardiograms in 2 different hospitals between 2002 and 2017. Follow-up between the first and last echocardiographic examination was at least one year. Hemodynamics of the BAV and aortic dimensions were assessed using annualized progression rate. The mean follow-up time was 6. 3±3. 6 years in the NP group and 7. 2±3. 2 years in the P group (p=0,47). Clinical and echocardiographic variables were comparable at baseline between the two groups (Table 1). At follow-up, pregnancy showed no impact on the LVOT dilatation (NP: 0. 01±0. 03 vs P: 0. 0±0,0 cm/year; p=0. 16) or on the dilatation of the ascending aorta (NP: 0. 02±0. 04 vs P: 0. 04±0. 05 cm/year; p=0. 24). However, women in the P group had an increased indexed stroke volume (NP: -0. 48±1. 78 vs P: 1. 43±1. 53 ml/year; p=0. 004) and thus no change in indexed aortic valve area (NP: -0. 03±0. 02 vs P: 0. 01±0. 06 cm2/m2/year; p=0. 07) as opposed to the NP group, even though the second echocardiogram was 5,06±3,74 years post-delivery. There was no difference in changes in mean gradients (NP: 0,48±1,22 vs P: 0,25±0,95 mmHg; p=0,55). After adjustment for age, hypertension and severity of valvular disease at baseline, pregnancy was not associated with a faster progression of the aortic valve disease (all p> 0. 13) nor aortic dilatation (p=0,06), while it was associated with a higher indexed stroke volume (p= 0. 005).

CONCLUSION: In women with bicuspid aortic valve disease with minimal to mild impairment, pregnancy does not result in accelerated deterioration of the valve or aorta-related disease.
BACKGROUND: Pregnancy in women with bicuspid aortic valves (BAV) is considered at risk as it might have an impact on mother and child health. However, no studies have clearly established the effect of pregnancy on the evolution of the BAV disease (aortic dilatation and valve dysfunction). The aim of this study was to compare the evolution of BAV disease in women who underwent at least one pregnancy versus women without any pregnancy.

METHODS AND RESULTS: This is a retrospective cohort study where 34 women with a confirmed BAV were frequency matched. 18 of them never underwent any pregnancy (non-pregnant group: NP) and 16 had at least one pregnancy (pregnancy group: P). Patients were followed with several echocardiograms in 2 different hospitals between 2002 and 2017. Follow-up between the first and last echocardiographic examination was at least one year. Hemodynamics of the BAV and aortic dimensions were assessed using annualized progression rate. The mean follow-up time was 6. 3±3. 6 years in the NP group and 7. 2±3. 2 years in the P group (p=0,47). Clinical and echocardiographic variables were comparable at baseline between the two groups (Table 1). At follow-up, pregnancy showed no impact on the LVOT dilatation (NP: 0. 01±0. 03 vs P: 0. 0±0,0 cm/year; p=0. 16) or on the dilatation of the ascending aorta (NP: 0. 02±0. 04 vs P: 0. 04±0. 05 cm/year; p=0. 24). However, women in the P group had an increased indexed stroke volume (NP: -0. 48±1. 78 vs P: 1. 43±1. 53 ml/year; p=0. 004) and thus no change in indexed aortic valve area (NP: -0. 03±0. 02 vs P: 0. 01±0. 06 cm2/m2/year; p=0. 07) as opposed to the NP group, even though the second echocardiogram was 5,06±3,74 years post-delivery. There was no difference in changes in mean gradients (NP: 0,48±1,22 vs P: 0,25±0,95 mmHg; p=0,55). After adjustment for age, hypertension and severity of valvular disease at baseline, pregnancy was not associated with a faster progression of the aortic valve disease (all p> 0. 13) nor aortic dilatation (p=0,06), while it was associated with a higher indexed stroke volume (p= 0. 005).

CONCLUSION: In women with bicuspid aortic valve disease with minimal to mild impairment, pregnancy does not result in accelerated deterioration of the valve or aorta-related disease.
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