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Background
The etiology of aortic valve stenosis (AS) in women of childbearing age is most commonly related to congenitally bicuspid aortic valves. In developing countries, AS from rheumatic heart disease may be more common and is usually associated with mitral valve disease. The classic symptoms associated with AS include: heart failure symptoms, chest pain, and presyncope/syncope. Severe AS is defined as: 1) an aortic valve area < 1 cm², 2) a mean gradient across the aortic valve >40 mmHg, or 3) a peak gradient across the aortic valve >64 mmHg by echocardiography.
In addition to AS, women with bicuspid valves may have an associated aortopathy or aortic dilatation even in the absence of hemodynamically significant aortic stenosis or regurgitation. Aortic coarctation can occur in conjunction with bicuspid aortic valve disease. Left ventricular outflow tract obstruction from other causes such as supravalvular stenosis (with or without Williams-Beuren syndrome) or subvalvular stenosis (discrete membrane or tunnel-type) and are physiologically similar to aortic valve stenosis.
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