Another rare cause of aortopathy in pregnancy is Takayasu’s arteritis. Dissection is rare. Severe hyper- tension, arterial occlusions, and acute aortic regurgita- tion are more common. In the largest series, about 25%
of pregnancies resulted in fetal death .[ 50 ]
Conclusions
Aortopathies include a wide range of acquired, genetic, and congenital disorders, many of which have multisys- tem involvement. Prepregnancy counseling is manda- tory in women with a known or suspected aortopathy.
Th is should include a multidisciplinary discussion with appropriate genetic, cardiac, obstetric, anesthetic, and neonatal input. Although a diverse group of dis- eases, there are guiding principles that assist in mak- ing appropriate complex management plans that these patients require .
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© Cambridge University Press 2016.
Chapter
Practical practice points
1. Severe valvular stenosis is poorly tolerated in pregnancy.
2. Rheumatic mitral stenosis is the leading cardiac cause of maternal death in the developing world.
3. Th e initial presentation of many women with rheumatic mitral stenosis occurs when pregnancy precipitates symptoms for the fi rst time.
4. Diuretics and beta-blockers are useful in medical management, but balloon mitral valvuloplasty has a high success rate and is the mainstay of treatment for severe mitral stenosis in pregnancy .
5. Bicuspid aortic valve is the commonest cause of aortic stenosis in women of childbearing age.
6. Preconception assessment is important to determine whether a woman with moderate or severe aortic stenosis is likely to tolerate pregnancy well, or whether she should undergo prepregnancy aortic valve replacement.
7. Th e severely stenotic bicuspid aortic valve in adulthood is oft en unsuitable for balloon valvotomy, so surgical aortic valve replacement may be necessary if a woman with severe aortic stenosis decompensates during pregnancy .