Navigating the Aortopathy Dilemma in Pregnancy

Aortic dissection during pregnancy most commonly occurs in women with undiagnosed aortopathies. High-risk aortopathies can be managed successfully throughout pregnancy within a pregnancy heart team model of care. The 2025 European Society of Cardiology guidelines provide comprehensive recommendations on the management of cardiac disease during pregnancy. We describe 4 cases of high-risk and very-high risk aortopathies that were successfully managed through pregnancy, including 1 patient with bicuspid aortic valve aortopathy who underwent successful cardiac surgery in the early second trimester. Pregnancy should no longer be a barrier to gold-standard or guideline-directed care for our high-risk cardiac patients.