Background: Pregnancy can increase gradients across the heart valves, and consequently deteriorates maternal and fetoneonatal conditions. So, pregnancy during heart valve diseases can be challenging and we need to risk stratify patients before conception. We tried to assess the role of preconception consultation using treadmill stress echocardiography (TSE) testing for identifying pregnancy outcomes in women with mitral valve stenosis (MS) or aortic valve stenosis (AS).
Methods: Pregnant patients with a diagnosis of MS or AS were evaluated from January 2015 to December 2018. First group included patients undergoing the TSE testing and they were permitted to get pregnant if they met pre-defined criteria. Second group comprised of women who did not undergo TSE testing. Maternal and fetoneonatal outcomes were also recorded.
Results: A total of 29 and 18 patients with MS and AS, respectively, were recruited. Among MS patients, individuals without TSE had more functional deterioration (11.1% versus 35%) and more fetoneonatal events (22.2% versus 55%) compared with those undergoing TSE. The rates of maternal events and mitral valvuloplasty during pregnancy were significantly higher in patients without TSE compared with those undergoing TSE (p = 0.015 and p = 0.042, respectively). Among AS patients, maternal and fetoneonatal events were higher in patients without TSE compared with those undergoing TSE, but those were comparable.
Conclusions: Pregnant patients with left-sided valvular stenosis who received preconception TSE testing had better outcomes compared with those who did not undergo preconception consultation. This underscores the utility of stress echocardiography in the risk stratification of pregnancies. (NCI-2021-5-4/R2)