Frequency of cardiovascular events in women with a congenitally bicuspid aortic valve in a single community and effect of pregnancy on events

Pregnancy and congenitally bicuspid aortic valve (BAV) are thought to be risk factors for aortic dissection; however, the population-based risk for patients with the 2 risk factors remains unknown. We investigated the relation between pregnancy and ascending aortic events in women with congenital BAV living in Olmsted County, Minnesota. Our institutional echocardiographic database was searched for women residing in Olmsted County with congenital BAV diagnosed from 1980 to 1999. We reviewed medical records for end points of aortic events (dilatation, dissection, or surgery) and aortic valve replacement (AVR). Obstetric history and further outcome follow-up were collected by postal survey. We identified 88 women with BAV. Median age at diagnosis was 35 years. Obstetric history totaled 216 pregnancies and 186 deliveries. There were no aortic dissections. During follow-up (median 12.3 years), 24 patients underwent AVR (n = 14), ascending aortic surgery (n = 3), or AVR and ascending aortic surgery (n = 7). Pregnancy was not associated with dilatation of the aorta, aorta surgery, or AVR. At echocardiographic diagnosis of BAV, 5 patients (6%) had aortas >40 mm in greatest diameter and 1 patient has >50 mm. Of 60 patients with serial echocardiograms for comparison (median interval 10.7 years), 21 patients (35%) had aortas measuring >40 mm in greatest dimension and 2 patients had >50 mm. In conclusion, aortic dissection in women with BAV and pregnancy is rare in the community. There is a significant rate of progressive enlargement of the aorta, warranting longitudinal follow-up.