Aortic Outflow Tract Obstruction and Trying to Conceive and Pregnancy

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I was born with aortic stenosis and when i was maybe 4 or 5 I had an angioplasty to try and widen my valve. Unfortunately that was unsuccessful so within a year I had open heart surgery where the surgeon actually went in to surgically widen my valve. I was good till I was about 22 when I noticed I started to get short of breath even with the simplest tasks like carrying my laundry up and down the stairs. At that point I decided to have the "Ross Procedure" done, as I knew I still wanted to have children someday and did not want to be on blood thinners. I have had no real problems since this last surgery and just this last November at the age of 28 my husband and I decided we were ready to begin a family. We met with the OBGYN and cardiologist and got approval for both to begin trying to conceive. We were able to get pregnant pretty quickly and were excited to learn in January 2017 that we were expecting. At 12 weeks I had an echo cardiogram done just to monitor my heart during pregnancy. Unfortunately I experienced a missed miscarriage at 13 weeks (the baby only measured 9 weeks). We had a D&C done immediately, and within the same week I met with my cardiologist to review my echo. He advised to have a trans esophageal echo done. He also advised that the regular echo was showing I had just barely moderate obstruction of the aortic outflow tract, but saw no that if the trans esophageal echo showed no real changes we were save to try again for a baby, but that he wanted me to meet with a congenital heart doctor at The Ohio State University Hospital (Dr. Daniels). The trans esophageal echo showed just slightly a little more severity moving me into the definite moderate range but by no means severe.

The following are my results:
SUMMARY:

1. Left ventricle: The cavity size was normal. Wall thickness was
increased. Systolic function was normal. The estimated ejection
fraction was in the range of 65% to 70%. Narrowed and tubular
left ventricular outflow tract measuring 1.1 cm at the lowest
measurement. Peak left ventricular outflow tract velocity of 1.2
m/sec but "aortic valve" peak velocity is 3.63 m/sec. Left
ventricular outflow tract velocity maybe underestimating the
velocity as left ventricular outflow tract is long and tubular.
Suspect that there is at least moderate sub valvular aortic
stenosis secondary to narrowed left ventricular outflow tract
causing significant turbulence. AI adding to the increased flow
as well. Acceleration time is 98 msec. AVA by plannimetry is 2.5
cm2.
2. Aortic valve: Prior repair procedures included Ross procedure. A
homograft bioprosthesis was present. There was regurgitation
directed eccentrically in the LVOT. There was moderate
perivalvular regurgitation. Incomplete coaptation in some views
maybe causing some AI. It is very eccentric so suspect moderate
severity.
3. Mitral valve: No evidence of vegetation.
4. Right ventricle: The cavity size was normal. Systolic function
was normal.
5. Atrial septum: Echo contrast study showed no right-to-left
atrial level shunt, following an increase in RA pressure induced
by provocative maneuvers.
6. Tricuspid valve: No evidence of vegetation.
7. Pulmonic valve: A homograft bioprosthesis was present. peak
velocity of 1.5 m/sec. Appears within normal range for
homograft.

I have yet to actually talk to my Dr. since the trans esophageal echo, instead I have been playing phone tag with his nurse, who last suggested we wait on trying to conceive until we had heard from OSU. Unfortunately we are not able to get into OSU till August. I am growing very frustrated with having to wait because I am almost thirty and I do know I will have to have open heart surgery for valve replacement likely in the next few years, at which point I would like to get the mechanical as to prevent any future surgeries (so I guess in a since I feel my biological clock ticking). And I also am questioning how just a few months ago it was OK for me to try and conceive and now its an issue. What would have happened had I still been pregnant because according to my OBGYN there is no real reason I miscarried and it was likely chromosomal.

If anyone can offer a similar situation in which they were pregnant or trying to conceive I would love to hear it.
Thank you so much!
 
I'm sorry for your loss and I hope that you will be able to try again and carry to term. It is always hard but in these circumstances I imagine doubly so.

Are you able to just schedule an appointment with your cardiologist rather than trying to get an answer over the phone? That's what I would do, this is a more intense discussion and needs an appointment.

My situation is different from yours in that I did not know I had a stenotic mitral valve before I became pregnant with twins. I ended up developing congestive heart failure and the twins were delivered via emergency C-section at 27 weeks gestation. Both my son and I coded during the delivery and my husband overheard staff putting my chance of survival at 50-50.

The twins and I are fine now (14 years old), but they were in the hospital for four months and very ill for two years, and we took a huge financial hit. I had them at age 34.

So . . . . it is worth some caution. It's only been 6 months since you decided to have children, you are only 28 (or 29), you & hubs have demonstrated strong fertility (hopefully that continues), so I think you do have until August if it is safer to wait for OSU.

Would there be any other second opinion you could get earlier?

Have you consulted a perinatologist, or just a regular OB GYN? I think you deserve a peri in your case.

Do you live near a hospital that has a NICU and a good cardiology department if you were to deliver early or have complications?

I hope you will get the green light soon and that everything goes well.
 

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