What is your approach to medical management and echocardiographic surveillance for pregnant patients with severe aortic stenosis during the first, second, and third trimesters?

There is no need for routine echocardiographic surveillance during pregnancy if the patient is asymptomatic and there is no change in the level of BNP. The echo can be helpful for the assessment of pulmonary pressure in patient who develops symptoms .Change in the BNP

level and echocardiographic PA pressures can help to differentiate between symptoms related to hemodynamic

deterioration and those associated with physiological changes of normal pregnancy. However, PA pressures may be overestimated by echocardiogram during pregnancy, therefore, invasive hemodynamic evaluation should be considered prior to any catheter-based intervention. An increased pressure gradient across the AV alone is expected due to increased stroke volume during pregnancy, and is not

an indication for intervention in the asymptomatic patient.atic patient