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.