{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:48:28Z","timestamp":1777052908094,"version":"3.51.4"},"reference-count":47,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Heart disease affects 0.1% to 4% of pregnant women, with congenital heart defects being the leading cause in developed countries. While maternal mortality is generally low, pre-existing cardiac conditions substantially increase adverse outcome risks. This report describes the multidisciplinary management of a pregnant patient with a bicuspid aortic valve, severe aortic stenosis, and ascending aortic ectasia. Case Presentation: A 34-year-old pregnant woman, asymptomatic but at high risk (World Health Organization Class III) for hemodynamic decompensation, was closely monitored throughout gestation. At 36 weeks, intrauterine growth restriction was detected, prompting an elective cesarean delivery at 38 weeks. Postpartum, the patient developed pre-eclampsia, which was managed successfully. Imaging revealed progressive aortic dilation, leading to surgical aortic valve replacement and ascending aorta reduction plasty. Post-operatively, atrioventricular reentrant tachycardia from an unrecognized accessory pathway developed; medical therapy effectively controlled the arrhythmia after failed catheter ablation. One year later, both mother and child remained in good health. Discussion: This case illustrates the complexity of managing pregnancy in women with congenital heart disease and significant aortic pathology. The physiological changes of pregnancy can exacerbate underlying lesions, necessitating individualized risk assessment, vigilant monitoring, and timely intervention. Conclusions: A multidisciplinary approach involving cardiology, obstetrics, anesthesiology, and genetics is essential to optimize outcomes for pregnant women with significant heart disease. As advances in care allow more women with congenital heart defects to reach childbearing age, structured care pathways remain vital for ensuring safe pregnancies and long-term cardiovascular health.<\/jats:p>","DOI":"10.3390\/diagnostics15162099","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T15:53:37Z","timestamp":1755705217000},"page":"2099","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Severe Aortic Stenosis and Pre-Excitation Syndrome in Pregnancy\u2014A Multidisciplinary Approach"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1064-8698","authenticated-orcid":false,"given":"Miruna Florina","family":"\u015etefan","sequence":"first","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital of Bucharest, 050098 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3913-4714","authenticated-orcid":false,"given":"Lucia \u015etefania","family":"Magda","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital of Bucharest, 050098 Bucharest, Romania"},{"name":"Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 020021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3300-9944","authenticated-orcid":false,"given":"Catalin Gabriel","family":"Herghelegiu","sequence":"additional","affiliation":[{"name":"Sanador Clinical Hospital, 011021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doru","family":"Herghelegiu","sequence":"additional","affiliation":[{"name":"Sanador Clinical Hospital, 011021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1247-339X","authenticated-orcid":false,"given":"Oana Aurelia","family":"Zimnicaru","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital of Bucharest, 050098 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catalin Constantin","family":"Badiu","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital of Bucharest, 050098 Bucharest, Romania"},{"name":"Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 020021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Claudia Berenice","family":"Suran","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital of Bucharest, 050098 Bucharest, Romania"},{"name":"Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 020021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea Elena","family":"Velcea","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital of Bucharest, 050098 Bucharest, Romania"},{"name":"Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 020021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Calin","family":"Siliste","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital of Bucharest, 050098 Bucharest, Romania"},{"name":"Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 020021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9054-8779","authenticated-orcid":false,"given":"Drago\u0219","family":"Vinereanu","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital of Bucharest, 050098 Bucharest, Romania"},{"name":"Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 020021 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.1093\/eurheartj\/ehy340","article-title":"2018 ESC Guidelines for the Management of Cardiovascular Diseases during Pregnancy","volume":"39","author":"Bauersachs","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/eurheartj\/ehs270","article-title":"Outcome of Pregnancy in Patients with Structural or Ischaemic Heart Disease: Results of a Registry of the European Society of Cardiology","volume":"34","author":"Ruys","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1016\/j.jacc.2009.12.068","article-title":"Bicuspid Aortic Valve Disease","volume":"55","author":"Siu","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.ijcard.2007.03.134","article-title":"Risk of Complications during Pregnancy in Women with Congenital Aortic Stenosis","volume":"126","author":"Yap","year":"2008","journal-title":"Int. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.amjcard.2010.08.061","article-title":"Frequency of Cardiovascular Events in Women with a Congenitally Bicuspid Aortic Valve in a Single Community and Effect of Pregnancy on Events","volume":"107","author":"McKellar","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/0002-9149(70)90761-7","article-title":"The Congenitally Bicuspid Aortic Valve: A Study of 85 Autopsy Cases","volume":"26","author":"Roberts","year":"1970","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1161\/01.CIR.0000027905.26586.E8","article-title":"Clinical and Pathophysiological Implications of a Bicuspid Aortic Valve","volume":"106","author":"Fedak","year":"2002","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/S0735-1097(00)01198-0","article-title":"The Effect of Valvular Heart Disease on Maternal and Fetal Outcome of Pregnancy","volume":"37","author":"Hameed","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1161\/HYPERTENSIONAHA.117.10803","article-title":"Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice","volume":"72","author":"Brown","year":"2018","journal-title":"Hypertension"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S1108","DOI":"10.1016\/j.ajog.2020.08.045","article-title":"Prevention of Preeclampsia with Aspirin","volume":"226","author":"Rolnik","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S1211","DOI":"10.1016\/j.ajog.2020.10.027","article-title":"Postpartum Preeclampsia\/Eclampsia: Defining Its Place and Management among the Hypertensive Disorders of Pregnancy","volume":"226","author":"Hauspurg","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Dhein, S., Seidel, T., Salameh, A., Jozwiak, J., Hagen, A., Kostelka, M., Hindricks, G., and Mohr, F.W. (2014). Remodeling of Cardiac Passive Electrical Properties and Susceptibility to Ventricular and Atrial Arrhythmias. Front. Physiol., 5.","DOI":"10.3389\/fphys.2014.00424"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the Management of Valvular Heart Disease: Developed by the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102129","DOI":"10.1016\/j.jaccas.2023.102129","article-title":"Unicuspid Aortic Valve With Severe Aortic Stenosis and Progressive Heart Failure During Pregnancy","volume":"28","author":"Quain","year":"2023","journal-title":"JACC Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/00003081-197509000-00007","article-title":"Circulatory Changes in Pregnancy","volume":"18","author":"Ueland","year":"1975","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jacc.2016.05.050","article-title":"High-Risk Cardiac Disease in Pregnancy: Part II","volume":"68","author":"Elkayam","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.ccl.2012.05.004","article-title":"Physiologic Changes During Normal Pregnancy and Delivery","volume":"30","author":"Ouzounian","year":"2012","journal-title":"Cardiol. Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1136\/hrt.68.12.540","article-title":"Adaptation of the Maternal Heart in Pregnancy","volume":"68","author":"Hunter","year":"1992","journal-title":"Br. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1016\/j.ijcard.2012.04.143","article-title":"Aortic Balloon Valvuloplasty in Pregnancy for Symptomatic Severe Aortic Stenosis","volume":"162","author":"Dawson","year":"2012","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1017\/S104795111800001X","article-title":"Severe Bicuspid Aortic Stenosis in Pregnancy: Balancing the Risk of Prematurity and Maternal Mortality","volume":"28","author":"Nwabuobi","year":"2018","journal-title":"Cardiol. Young"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100022","DOI":"10.1016\/j.jacadv.2022.100022","article-title":"Catheter-Based Interventions for the Management of Valvular Heart Disease During Pregnancy","volume":"1","author":"Elkayam","year":"2022","journal-title":"JACC Adv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1136\/heartjnl-2014-306729","article-title":"Pregnancy and Native Heart Valve Disease","volume":"102","author":"Thorne","year":"2016","journal-title":"Heart"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.amjcard.2016.07.005","article-title":"Echocardiographic Evaluation of Hemodynamic Changes in Left-Sided Heart Valves in Pregnant Women With Valvular Heart Disease","volume":"118","author":"Samiei","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/j.jacc.2016.07.750","article-title":"Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry","volume":"68","author":"Orwat","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1093\/rpd\/ncaa059","article-title":"To Use or Not Use Patient Shielding on Pregnant Women Undergoing Ct Pulmonary Angiography: A Phantom Study","volume":"189","author":"Begano","year":"2021","journal-title":"Radiat. Prot. Dosim."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"102104","DOI":"10.1016\/j.jaccas.2023.102104","article-title":"TAVR Beyond Fetal Viability: An Alternative to Preterm Delivery in Symptomatic Severe Aortic Stenosis","volume":"27","author":"Hoover","year":"2023","journal-title":"JACC Case Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1136\/heartjnl-2022-322328","article-title":"Pregnancy-Related Aortic Complications in Women with Bicuspid Aortic Valve","volume":"109","author":"Serrano","year":"2023","journal-title":"Heart"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1136\/heartjnl-2020-318183","article-title":"Pregnancy Outcome in Thoracic Aortic Disease Data from the Registry of Pregnancy and Cardiac Disease","volume":"107","author":"Campens","year":"2021","journal-title":"Heart"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.tjog.2013.06.018","article-title":"Bicuspid Aortic Valve in Pregnancy","volume":"53","author":"Yuan","year":"2014","journal-title":"Taiwan. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Herghelegiu, C.G., Veduta, A., Stefan, M.F., Magda, S.L., Ionascu, I., Radoi, V.E., Oprescu, D.N., and Calin, A.M. (2023). Hyperglycosylated-HCG: Its Role in Trophoblast Invasion and Intrauterine Growth Restriction. Cells, 12.","DOI":"10.3390\/cells12121647"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.jacc.2014.04.073","article-title":"A Roadmap to Investigate the Genetic Basis of Bicuspid Aortic Valve and Its Complications: Insights from the International BAVCon (Bicuspid Aortic Valve Consortium)","volume":"64","author":"Prakash","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","first-page":"17","article-title":"Evidence of Aortopathy in Mice with Haploinsufficiency of Notch1 in Nos3-Null Background","volume":"2","author":"Koenig","year":"2015","journal-title":"J. Cardiovasc. Dev. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1038\/nature03940","article-title":"Mutations in NOTCH1 Cause Aortic Valve Disease","volume":"437","author":"Garg","year":"2005","journal-title":"Nature"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1016\/S0735-1097(97)00372-0","article-title":"A Prospective Study to Assess the Frequency of Familial Clustering of Congenital Bicuspid Aortic Valve","volume":"30","author":"Huntington","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/j.amjcard.2006.05.035","article-title":"Morphology and Function of the Bicuspid Aortic Valve With and Without Coarctation of the Aorta in the Young","volume":"98","author":"Ciotti","year":"2006","journal-title":"Am. J. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"780","DOI":"10.21037\/cdt.2018.09.20","article-title":"Bicuspid Aortic Valve and Aortic Coarctation in Congenital Heart Disease\u2014Important Aspects for Treatment with Focus on Aortic Vasculopathy","volume":"8","author":"Sinning","year":"2018","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2915","DOI":"10.1093\/eurheartj\/ehq249","article-title":"ESC Guidelines for the Management of Grown-up Congenital Heart Disease (New Version 2010)","volume":"31","author":"Baumgartner","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC Guidelines for the Management of Peripheral Arterial and Aortic Diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"107604","DOI":"10.1016\/j.carpath.2024.107604","article-title":"Bicuspid Aortic Valve: The Most Frequent and Not so Benign Congenital Heart Disease","volume":"70","author":"Thiene","year":"2024","journal-title":"Cardiovasc. Pathol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.amjcard.2008.02.106","article-title":"A Critical Review of the American College of Cardiology\/American Heart Association Practice Guidelines on Bicuspid Aortic Valve With Dilated Ascending Aorta","volume":"102","author":"Guntheroth","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_41","first-page":"178","article-title":"Unmasking of Pre-Excitation after Aortic Valve Surgery\u2014A Report of Two Cases","volume":"7","author":"Tapanainen","year":"2021","journal-title":"Heart Rhythm Case Rep."},{"key":"ref_42","first-page":"208","article-title":"Unmasking of Benign Wolff-Parkinson-White Pattern under General Anesthesia","volume":"47","author":"Chhabra","year":"2003","journal-title":"Indian J. Anaesth."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1136\/hrt.69.5.446","article-title":"Unmasking of Left Free Wall Ventricular Preexcitation by His Bundle Ablation","volume":"69","author":"Visman","year":"1993","journal-title":"Heart"},{"key":"ref_44","first-page":"251","article-title":"Unmasking Accessory Pathway Conduction Due to AV Block Following Tricuspid Valve Replacement","volume":"14","author":"Simmers","year":"2006","journal-title":"Neth. Heart J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.amjcard.2017.04.055","article-title":"Sinus Tachycardia With Variable QRS Morphology","volume":"120","author":"Breaux","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e12911","DOI":"10.1111\/anec.12911","article-title":"Atrioventricular Accessory Pathway Unmasked by Heart Valve Replacement","volume":"27","author":"Long","year":"2022","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2945","DOI":"10.21037\/jtd.2019.07.27","article-title":"Surgical Technique Modifies the Postoperative Atrioventricular Block Rate in Sutureless Prostheses","volume":"11","author":"Barbeito","year":"2019","journal-title":"J. Thorac. Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2099\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:32:15Z","timestamp":1760034735000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":47,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["diagnostics15162099"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15162099","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]}}}