A 35-year-old woman with a bicuspid aortic valve, moderate-severe aortic stenosis and severe aortic dilatation underwent aortic valve and ascending aorta replacement when 14 weeks pregnant. We discuss the risks of aortic dilatation associated with bicuspid aortic valves during pregnancy and options for management. Included is a summary of the management of mechanical valves during pregnancy and delivery. This case emphasises the importance of multi-disciplinary counselling and patient-centred, informed decision making.
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