Pregnancy, bicuspid aortic valve disease and aortic aneurysms

Hi! I am a 30 year old female with bicuspid aortic valve disease diagnosed when I was 26. I have not had a valve replacement yet, but I did have an ascending aortic aneurism repair 4 years ago. My last echo showed mild leakage, but my concern is my blood pressure and pulse. Typically my BP is anywhere from 112/42 to 120/57 and my pulse is usually right at 60. My diastolic is always very low and when it drops below 50 I can tell because I get a crushing headache and I become completely lethargic. I am overweight and not an athlete. I did work out a lot this summer, but my idea of working out isn't extreme- running a 1/2 mile and walking a few miles... or doing 40 minutes on the elliptical. Currently I am 22 weeks pregnant and although my diastolic has always been low, it has never been this low before. The only thing that helps my headache and energy level is when I drink a redbull. Coffee doesn't work... I have to wonder if it could be the vitamin B in the redbull... 

Your symptoms are suggestive of aortic valve leakage and resulting mild/moderate heart failure, made worse by the increased circulatory demands of your pregnancy. I wonder why your valve was not repaired while you had the ascending aortic aneurysm fixed. For now, you need to have another cardiac echo to evaluate this. If true, the only way to fix this is with surgery, but sometimes it may be possible to avoid this for now with careful management by your cardiologists.
Hope this helps,
Dr T


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