Study Population
A single-center retrospective study was conducted using the Cardiology Obstetrics (COB) database at St. Paul’s Hospital (Vancouver, Canada). Consecutive, retrospective pregnancies were identified with established diagnosis of congenital LVOTO/AS (bicuspid aortic valve; bicuspid aortic valve/aortic coarctation; sub-valvular aortic stenosis; and bicuspid aortic valve/sub-valvular stenosis) who underwent singleton pregnancy between February 2008 and December 2020. In order to be included, each pregnant woman had to have at least 2 comprehensive transthoracic echocardiograms (TTE) during index pregnancy, each performed during a different trimester. Exclusion criteria included: (1) previous valve surgery; (2) other moderate or severe heart valve disease; (3) cardiomyopathy with LVEF < 40%; (4) persistent arrhythmias; (5) pregnancy terminated at < 20 weeks gestation; (6) age less than 18 years; (7) presence of other medical comorbidities; and (8) poor image quality such that comprehensive echocardiographic assessment of left ventricular function and semi-automated GLS analysis could not be performed. For the control group, healthy age-matched women with a singleton pregnancy who were referred to the COB clinic with comprehensive echocardiography at the time of referral but found to have no evidence of significant cardiac disease were enrolled. All patients provided written consent and approval was obtained from the University of British Columbia’s Research Ethics Board.