A 30 year old lady with a background of severe aortic stenosis presents at 38 weeks of gestation of her first pregnancy complaining of mild persistent dyspnea. She had no cardiac symptoms at conception, but started experiencing mild intermittent dyspnea from the 2nd trimester onwards. She was otherwise normal when evaluated at 36 weeks.
The aortic valve area is 0.7 cm², with a transvalvular gradient of 60 mmHg. Left ventricular hypertrophy is noted, with a posterior wall thickness of 10 mm. Mild diastolic dysfunction is present. The ejection fraction is 65%.
The baseline heart rate is 150 bpm, with normal variability. Two accelerations are seen; there are no decelerations.
WBC/DC: 8,000/mm3 (4,600-11,000) Hb: 15.0 g/dL (11-18) Platelets: 380,000/mm3 (150,000-400,000)
The X-ray of the chest is completely normal.