(106) Hemodynamic Monitoring of Aortic and Mitral Stenosis in Pregnancy

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Abra Guo, MD

Cardiology Fellow, PGY-6
University Of Minnesota Medical Center
University of Minnesota Medical Center, MN, United States

Coauthor(s)

KT

Katelyn M. Tessier, BS, MS

Senior Biostatistician
University of Minnesota
Minneapolis, Minnesota, United States
CD

Connor Demorest, BS, MS

Biostatistician
Masonic Cancer Center, University of Minesota
University of Minnesota/Minneapolis, Minnesota, United States
SC

Selma Carlson, MD

University of Minnesota Medical Center/ Minneapolis VA Healthcare System
University of Minnesota Medical Center, Minnesota, United States
Bethany Sabol, MD

Assistant Professor
University of Minnesota
Minneapolis, Minnesota, United States
Sarah A. Wernimont, MD, PhD

Assistant Professor
University of Minnesota
Minneapolis, MN, United States
JS

Jessica Schultz, MD

University of Minnesota Medical Center
Minneapolis, Minnesota, United States

Objective: Valvular heart disease accounts for one-third of heart disease in pregnant individuals with stenotic valvular lesions, particularly left-sided lesions, increasing the risk of adverse maternal outcomes. A major challenge is the lack of normative data describing the echocardiographic changes in this population throughout pregnancy. We sought to establish how peak velocity and mean gradient across stenotic native aortic and mitral valves change with increased hemodynamic volumes throughout pregnancy.

Study Design: This was a single-center retrospective cohort study using a large community-academic health outcomes database. Individuals with aortic and mitral valve stenosis who had at least one echo during pregnancy were identified via ICD-10 diagnosis and procedures codes from an access-protected database of pregnant patients who received care at our center between 2012 and 2023. Mean gradients were identified from transthoracic echocardiogram data throughout pregnancy. Clinical characteristics and differences in gradients were compared within the groups.

Results: Twenty-three patients were identified; 16 with aortic stenosis (AS) and 7 with mitral stenosis (MS). Clinical characteristics were similar amongst groups. The medians of aortic valve mean gradients (mmHg) were as follows: pre-pregnancy (14), second trimester (20), third trimester (13). The medians of peak aortic velocity (m/s) were as follows: pre-pregnancy (2.5), second trimester (3.0), third trimester (2.8). The medians of mitral valve mean gradients (mmHg) were as follows: pre-pregnancy (4.5), first trimester (7.0), second trimester (12.5), third trimester (12.0). No patients in this cohort progressed in degree of severity during pregnancy with most achieving term delivery (median gestational age at birth 38.64 (37.68, 39.51).

Conclusion: To our knowledge this is the first retrospective investigation of longitudinal changes in valve hemodynamics in pregnant patients with native valve stenosis. We demonstrate that peak velocity and mean gradient across native aortic and mitral valves increase in a predictable manner during pregnancy.