Pregnancy with Severe Valvular Disease in Low-Resource Populations (JACC Case Reports August 2024)-Article: Pregnancy with Severe Valvular Disease in Low-Resource Populations

Article: Pregnancy with Severe Valvular Disease in Low-Resource Populations

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This case report details the medical management of a 32-year-old pregnant woman suffering from severe aortic stenosis, particularly in a low-resource setting. Presented at 22 weeks of gestation with chest pain and shortness of breath, physical examination revealed aortic valve abnormalities and other symptoms like xanthomas and anemia. The woman had a complex obstetric history and family history of sudden cardiac death.<br /><br />Diagnostic investigations, including an electrocardiogram and transthoracic echocardiography (TTE), confirmed critical aortic stenosis and hypercholesterolemia. Medical management commenced with bisoprolol and folic acid, along with treatments for anemia. Weekly virtual follow-ups were conducted due to the patient's remote living circumstances, ensuring continuous monitoring.<br /><br />At 30 weeks gestation, she was hospitalized, and a multidisciplinary team handled her care. A cesarean section was performed under epidural anesthesia, and the baby was successfully delivered and transferred to the neonatal intensive care unit. Post-delivery, the patient was monitored and later discharged with plans for an aortic valve replacement.<br /><br />However, the patient returned postnatally with complications and underwent multiple surgical interventions, including aortic valve replacement and coronary artery bypass grafting. Unfortunately, the patient's condition deteriorated, leading to her death two days postoperatively.<br /><br />This case underlines the necessity of integrated care involving cardiologists, obstetricians, and anesthetists, supported by telemedicine for high-risk pregnancies in resource-limited settings. Continuous monitoring and timely interventions were crucial for managing this high-risk pregnancy. The report also emphasizes the importance of community awareness and screening for valvular heart diseases and familial hypercholesterolemia.

Keywords

aortic stenosis

pregnancy

low-resource setting

chest pain

shortness of breath

electrocardiogram

transthoracic echocardiography

multidisciplinary care

telemedicine

valvular heart diseases