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Vasconcelos MM, Ganan CS, da Silveira CFDSMP, Malagutte KNDS, Poiati JR, Nunes HRDC, Martin LC, Bazan R, Borges VTM, Bazan SGZ. Evolution of Myocardial Hypertrophy Associated With Pregnancy in Hypertensive Women Six Months Postpartum. Curr Probl Cardiol 2023; 48:101772. [PMID: 37121455 DOI: 10.1016/j.cpcardiol.2023.101772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/02/2023]
Abstract
Systemic arterial hypertension (SAH) is one of the principal risk factors for developing cardiovascular disease. When a hypertensive woman becomes pregnant, new hemodynamic condition is installed, with addition from chronic pressure overload to chronic volume overload. This new hemodynamic condition can provide greater myocardial hypertrophy(LVH), whose postpartum evolution has been little studied in the literature. To evaluate LVH in hypertensive women in the third trimester of pregnancy and 6 months postpartum and to establish which clinical variables are associated with elevated risk of LVH. Prospective longitudinal study including 41 pregnant women beyond 35 gestational weeks and with previous SAH. They were submitted to clinical and echocardiographic evaluation at the gestational period and 6 months postpartum. Statistical analysis: multivariate logistic regression with the exposures most strongly associated with maintenance of hypertrophy in univariate analysis. Significance level: P<0.05. The mean age was 29±6.2 years. The majority of the women were white(85.4%). Before pregnancy 23(59%) women used antihypertensive drugs and 28(71.8%) used during pregnancy. At the end of gestation, all women presented LVH, 79% maintained hypertrophy 6 months postpartum. In multivariate analysis, exposures significantly associated with hypertrophy maintenance: systolic blood pressure(SBP) at the end of gestation, OR=1.16(1.03-1.30);P=0.013 and SBP increase at 6 months postpartum in relation to end of gestation, OR=22.9(1.8-294);P=0.016. In hypertensive pregnant women, LVH frequency is elevated at the end of pregnancy, and recovery frequency of this hypertrophy, at 6 months postpartum, is very low. The increase of SBP 6 months postpartum was associated with maintenance of hypertrophy.
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Affiliation(s)
- Milena Miranda Vasconcelos
- Department of Internal Medicine, Botucatu Medical School - UNESP, São Paulo State University, Botucatu, Brazil
| | - Camilla Sousa Ganan
- Department of Internal Medicine, Botucatu Medical School - UNESP, São Paulo State University, Botucatu, Brazil
| | | | | | - Juliane Rosa Poiati
- Department of Gynecology and Obstetrics, Botucatu Medical School - UNESP, São Paulo State University, Botucatu, Brazil
| | | | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School - UNESP, São Paulo State University, Botucatu, Brazil
| | - Rodrigo Bazan
- Department of Internal Medicine, Botucatu Medical School - UNESP, São Paulo State University, Botucatu, Brazil
| | | | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School - UNESP, São Paulo State University, Botucatu, Brazil
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De Pinho A, Mota De Sousa A, Melo A, Ferreira A. Unknown rheumatic cardiac disease as cause of acute onset post-partum dyspnea: a case report. BMC Pregnancy Childbirth 2023; 23:489. [PMID: 37400772 PMCID: PMC10316575 DOI: 10.1186/s12884-023-05809-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Acute post-partum dyspnea configures an obstetric challenge with multiple differential diagnosis. CASE PRESENTATION We present a case of a previous healthy woman with preeclampsia who developed severe dyspnea 30 h after delivery. She complained of cough, orthopnea, and bilateral lower extremities oedema. She denied headaches, blurry vision, nausea, vomiting, fever or chills. Auscultation revealed a diastolic murmur, and was compatible with pulmonary oedema. A timely bedside echocardiogram showed moderate dilated left atrium with severe mitral insufficiency suggestive of an unknown rheumatic disease. She was managed with noninvasive ventilation, loop diuretics, vasodilators, thromboprophylaxis, head-end elevation, and fluid restriction with progressive improving. CONCLUSIONS Hemodynamic changes in pregnant patients with previously silent cardiac disease may pose a challenge and cause post-partum dyspnea. This scenario requires a timely and multidisciplinary approach.
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Affiliation(s)
- António De Pinho
- Obstetrics and Gynecology Department - Tâmega E Sousa Hospital Center, Penafiel - Porto, Avenida do Hospital Padre Américo 210, Penafiel, 4564-007, Portugal.
- Biomedicine Department - Faculty of Medicine, University of Porto, Porto, Portugal.
- Pediatrics and Gynecology/Obstetrics Department - Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Andreia Mota De Sousa
- Obstetrics and Gynecology Department - Tâmega E Sousa Hospital Center, Penafiel - Porto, Avenida do Hospital Padre Américo 210, Penafiel, 4564-007, Portugal
| | - Anabela Melo
- Obstetrics and Gynecology Department - Tâmega E Sousa Hospital Center, Penafiel - Porto, Avenida do Hospital Padre Américo 210, Penafiel, 4564-007, Portugal
| | - Anabela Ferreira
- Obstetrics and Gynecology Department - Tâmega E Sousa Hospital Center, Penafiel - Porto, Avenida do Hospital Padre Américo 210, Penafiel, 4564-007, Portugal
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3
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Curtis SL, Belham M, Bennett S, James R, Harkness A, Gamlin W, Thilaganathan B, Giorgione V, Douglas H, Carroll A, Kitt J, Colebourn C, Ribeiro I, Fairbairn S, Augustine DX, Robinson S, Thorne SA. Transthoracic Echocardiographic Assessment of the Heart in Pregnancy-a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society. Echo Res Pract 2023; 10:7. [PMID: 37076874 PMCID: PMC10116662 DOI: 10.1186/s44156-023-00019-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes which result in structural and functional adaptations in the cardiovascular system. An understanding of the myocardial adaptations is important for echocardiographers and clinicians undertaking or interpreting echocardiograms on pregnant and post-partum women. This guideline, on behalf of the British Society of Echocardiography and United Kingdom Maternal Cardiology Society, reviews the expected echocardiographic findings in normal pregnancy and in different cardiac disease states, as well as echocardiographic signs of decompensation. It aims to lay out a structure for echocardiographic scanning and surveillance during and after pregnancy as well as suggesting practical advice on scanning pregnant women.
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Affiliation(s)
- Stephanie L Curtis
- University Hospitals Bristol and Weston NHS Trust, Bristol Heart Institute, Marlborough Street, Bristol, BS2 8HW, UK.
| | - Mark Belham
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sadie Bennett
- University Hospitals of North Midlands, Stoke-On-Trent, UK
| | - Rachael James
- University Hospitals Sussex NHS FT, Brighton, UK
- United Kingdom's Maternal Cardiology Society, London, UK
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - Wendy Gamlin
- North West Heart Centre, Wythenshawe Hospital, Manchester, UK
| | | | | | | | | | - Jamie Kitt
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Isabel Ribeiro
- University Hospitals Bristol and Weston NHS Trust, Bristol Heart Institute, Marlborough Street, Bristol, BS2 8HW, UK
| | - Sarah Fairbairn
- University Hospitals Bristol and Weston NHS Trust, Bristol Heart Institute, Marlborough Street, Bristol, BS2 8HW, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Sara A Thorne
- University Health Network Toronto, Toronto General Hospital & Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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4
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Karpova NS, Dmitrenko OP, Budykina TS. Literature Review: The sFlt1/PlGF Ratio and Pregestational Maternal Comorbidities: New Risk Factors to Predict Pre-Eclampsia. Int J Mol Sci 2023; 24:ijms24076744. [PMID: 37047717 PMCID: PMC10095124 DOI: 10.3390/ijms24076744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
One of the main causes of maternal and neonatal morbidity and mortality is pre-eclampsia. It is characterized by a high sFlt1/PlGF ratio, according to prior research. Pregestational diseases in mothers may increase the risk of developing pre-eclampsia. Only a few studies have looked at the connection between maternal comorbidities before conception and the sFlt1/PlGF ratio. The most recent information regarding the association between maternal pregestational diseases and the ratio of sFlt1/PlGF is described in this review. The paper also examines current research suggesting that changes in pregnancy hormones and metabolites are related to a high sFlt1/PlGF ratio. Certain maternal disorders have been found to dramatically raise sFlt-1 and sFlt1/PlGF levels, according to an analysis of the literature. There is still debate about the data on the association between the sFlt1/PlGF ratio and maternal disorders such as HIV, acute coronary syndromes, cardiovascular function in the mother between 19 and 23 weeks of pregnancy, thyroid hormones, diabetes, and cancer. Additional research is needed to confirm these findings.
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Affiliation(s)
- Nataliia Sergeevna Karpova
- Federal State Budgetary Institution “Research Institute of Pathology and Pathophysiology”, St. Baltiyskaya, House 8, Moscow 125315, Russia
| | - Olga Pavlovna Dmitrenko
- Federal State Budgetary Institution “Research Institute of Pathology and Pathophysiology”, St. Baltiyskaya, House 8, Moscow 125315, Russia
| | - Tatyana Sergeevna Budykina
- State Budgetary Health Institution of the Moscow Region “Moscow Regional Research Institute of Obstetrics and Gynecology”, St. Pokrovka, d.22a, Moscow 101000, Russia
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5
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Schnettler WT, Zinn CK, Devaiah CG, Wilson J. Indications for Maternal Echocardiography in Detecting Disease and the Impact on Pregnancy Management. Am J Perinatol 2023; 40:305-312. [PMID: 33946113 DOI: 10.1055/s-0041-1728825] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Few obstetric-specific guidelines detail the indications for screening echocardiography in pregnancy. The objective of the study is to examine the association of common indications for maternal echocardiography with the likelihood of abnormality identification, pregnancy management alteration, and conformity with current American College of Cardiology Foundation (ACCF) guidelines. STUDY DESIGN This retrospective cohort analysis categorized all echocardiograms performed within pregnancy and the first month postpartum within a tertiary health system to correlate indications with abnormal findings. RESULTS Data from 226 echocardiograms were analyzed from 205 women. The most common indication for initial echocardiography was cardiac symptoms (34.6%). History of cardiac disease was the only indication demonstrating a significant association with an abnormal finding on initial echocardiography (odds ratio [OR]: 2.6; p = 0.006). Postpartum status (OR: 4.9; p < 0.001), multiparity (p < 0.001), and tobacco use (OR: 2.2; p = 0.011) were demographic characteristics associated with the identification of abnormal findings on initial echocardiography. Abnormal echocardiographic findings were associated with changes in clinical management but did not correlate with adverse obstetric or neonatal outcomes, which may support the impact of a multidisciplinary programmatic approach. ACCF appropriateness criteria correlated well with identification of abnormal echocardiographic results (p = 0.034). CONCLUSION Although the presence of cardiac symptoms or history of diabetes failed to demonstrate association with abnormal echocardiographic findings, a history of prior cardiac disease, tobacco use, multiparity, and postpartum status were factors associated with identification of abnormal findings on initial maternal echocardiography. The ACCF appropriateness criteria for obtaining echocardiography can be applied to pregnant women with consideration for these additional risk factors. KEY POINTS · The ACCF criteria are applicable in pregnancy for appropriateness of echocardiography indications.. · Several clinical factors often prompt performance of echocardiography in pregnancy without merit.. · Consideration for multiparty, tobacco abuse, and postpartum state should coincide with ACCF criteria..
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Affiliation(s)
- William T Schnettler
- Department of Obstetrics and Gynecology, TriHealth-Good Samaritan Hospital, Cincinnati, Ohio.,The Hatton Research Institute, TriHealth-Good Samaritan Hospital, Cincinnati, Ohio.,Division of Maternal-Fetal Medicine, TriHealth-Good Samaritan Hospital, Cincinnati, Ohio
| | - Caitlyn K Zinn
- Department of Obstetrics and Gynecology, TriHealth-Good Samaritan Hospital, Cincinnati, Ohio
| | - C Ganga Devaiah
- The Hatton Research Institute, TriHealth-Good Samaritan Hospital, Cincinnati, Ohio
| | - John Wilson
- Department of Cardiology, TriHealth Heart Institute, TriHealth-Good Samaritan Hospital, Cincinnati, Ohio
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Bonnin P, Constans B, Duhamel A, Kyheng M, Ducloy-Bouthors AS, Estevez MG, Tavernier B, Gaudet A. Accuracy and trending ability of finger plethysmographic cardiac output monitoring in late pregnancy. Can J Anaesth 2022; 69:1340-1348. [PMID: 35927539 DOI: 10.1007/s12630-022-02297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/22/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Individuals in late pregnancy are at risk of significant hemodynamic variations, especially during Cesarean delivery. Although non-invasive monitoring might enable the early detection of variations in cardiac output (CO), clinical validation is lacking. METHODS In a prospective, single-center study, we measured CO simultaneously with finger plethysmography and transthoracic echocardiography in 100 third-trimester pregnant individuals in the supine and left lateral decubitus (LLD) positions. RESULTS A Bland-Altman analysis revealed a mean (standard deviation) bias of 1.36 (1.04) L·min-1 in the supine position (95% limits of agreement, -0.68 to 3.4 L·min-1; percent error, 26.6%), indicating overestimation by finger plethysmography. The intra-class correlation coefficient was 0.43 (95% confidence interval [CI], 0.33 to 0.51). Regarding the changes in CO induced by the supine-to-LLD transition, the concordance rate in a four-quadrant plot was 98.3% (95% CI, 91.1 to 99.9%). CONCLUSION Our study showed a poor reliability of finger plethysmography for static measurement of CO. Nevertheless, finger plethysmography had a reasonably high concordance rate for the detection of CO changes secondary to positional changes in late-pregnant individuals. STUDY REGISTRATION DATE: www. CLINICALTRIALS gov (NCT03735043); registered 8 November 2018.
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Affiliation(s)
- Paul Bonnin
- CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France
| | - Benjamin Constans
- CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- Centre Hospitalier de Seclin-Carvin, Service d'Anesthésie, Seclin, France
| | - Alain Duhamel
- Université de Lille, CHU Lille, ULR 2694 METRICS- Evaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Unité de Méthodologie, Biostatistiques et Data Management, Lille, France
| | - Maéva Kyheng
- Université de Lille, CHU Lille, ULR 2694 METRICS- Evaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Unité de Méthodologie, Biostatistiques et Data Management, Lille, France
| | | | | | - Benoit Tavernier
- CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- Université de Lille, CHU Lille, ULR 2694 METRICS- Evaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Alexandre Gaudet
- CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France.
- Department of Intensive Care Medicine, Critical Care Centre, CHU Lille, 59000, Lille, France.
- Université de Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France.
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7
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Cupido B, Zühlke L, Osman A, van Dyk D, Sliwa K. Managing Rheumatic Heart Disease in Pregnancy: A Practical Evidence-Based Multidisciplinary Approach. Can J Cardiol 2021; 37:2045-2055. [PMID: 34571164 DOI: 10.1016/j.cjca.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022] Open
Abstract
Rheumatic heart disease (RHD) remains a leading cause of mortality and morbidity in pregnant patients in low- to middle-income countries. Apart from the clinical challenges, these areas face poor infrastructure and resources to allow for early detection, with many women presenting to medical services for the first time when they deteriorate clinically during the pregnancy. The opportunity for preconception counselling and planning may thus be lost. It is ideal for all women to be seen before conception and risk-stratified according to their clinical state and pathology. The role of the cardio-obstetrics team has emerged over the past decade with the aim of a seamless transition to and from the appropriate levels of care during pregnancy. Severe symptomatic mitral and aortic valve stenoses portend the greatest risk to both mother and fetus. In mitral stenosis, beta-blockers are the cornerstone of therapy and only a small number of patients require balloon valvuloplasty. Regurgitant lesions mostly require diuretics alone for the treatment of heart failure. The mode of delivery is usually vaginal; caesarean section is performed in those with obstetrical indications or in cases with severe stenosis and a poor clinical state. The postpartum period presents a second high-risk period for maternal adverse events, with heart failure and arrhythmias being the most frequent. This review aims to provide a practical evidence-based multi-disciplinary approach to the management of women with RHD in pregnancy.
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Affiliation(s)
- Blanche Cupido
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Liesl Zühlke
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa; The Deanery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ayesha Osman
- Department of Obstetrics and Gynaecology: Maternal Fetal Medicine Unit, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Dominique van Dyk
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
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8
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Afari HA, Davis EF, Sarma AA. Echocardiography for the Pregnant Heart. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:55. [PMID: 34075291 PMCID: PMC8160078 DOI: 10.1007/s11936-021-00930-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 01/22/2023]
Abstract
Purpose of review Pregnancy is associated with significant hemodynamic changes, making it a potentially high-risk period for women with underlying cardiovascular disease. Echocardiography remains the preferred modality for diagnosis and monitoring of pregnant women with cardiovascular disease as it is widely available and does not require radiation. This paper reviews the role of echocardiography along the continuum of pregnancy in at-risk patients, with a focus on key cardiac disease states in pregnancy. Recent findings In the preconception stage, risk stratification scores such as CARPREG II, ZAHARA and the modified WHO remain central to counseling and planning. As such, echocardiography serves an important role in assessing the severity of pre-existing structural disease. Among women with pre-existing cardiovascular disease who become pregnant-as well as those who develop cardiovascular symptoms during pregnancy-echocardiography is a key imaging tool for assessment of hemodynamic and structural changes and is recommended as the first-line imaging modality when appropriate by both the American College of Obstetricians and Gynecologists (ACOG) and the Food and Drug Administration (FDA). However, routine screening intervals during pregnancy for various cardiac lesions are not well defined, resulting in clinical heterogeneity in care. Summary Echocardiography is the imaging modality of choice for defining, risk stratifying, and monitoring cardiovascular changes throughout pregnancy. Once identified, at-risk patients should receive careful individual counseling and follow-up with a multidisciplinary team. Echocardiography serves as a widely available tool for serial monitoring of pregnant women with cardiovascular disease throughout pregnancy and the postpartum period.
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Affiliation(s)
| | - Esther F. Davis
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
| | - Amy A. Sarma
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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9
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Yamamura K, Duarte V, Karur GR, Graf J, Hanneman K, Geva T, Valente AM, Wald RM. The impact of pulmonary valve replacement on pregnancy outcomes in women with tetralogy of Fallot. Int J Cardiol 2021; 330:43-49. [PMID: 33571563 DOI: 10.1016/j.ijcard.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pregnant women with repaired tetralogy of Fallot (rTOF) are at increased risk of adverse outcomes. Although pre-pregnancy pulmonary valve replacement (PVR) may be considered in some women to attenuate risk, published data to support this practice are lacking. Our objective was to explore the impact of pre-pregnancy PVR on pregnancy outcomes in rTOF. METHODS Women with rTOF and cardiovascular magnetic resonance imaging (CMR) before and after pregnancy were included if CMR studies were completed within 3 years of pregnancy. Subjects were compared according to presence (+) or absence (-) of PVR at pre-pregnancy CMR. Pregnancy outcomes (cardiovascular, obstetric, and fetal/neonatal) were documented. RESULTS Of the 29 study women identified, 7 were PVR+ and 22 were PVR-. Post-pregnancy, the PVR- group demonstrated interval increase in indexed right ventricular end-diastolic volumes (RVEDVi) (157 ± 28 versus 166 ± 33 ml/m2, p = 0.003) and end-systolic volumes (RVESVi) (82 ± 17 versus 89 ± 20 ml/m2, p = 0.003) as compared with pre-pregnancy, but no significant change in RV ejection fraction, RV mass, or left ventricular measurements. In the PVR+ group, there were no interval changes in RV measurements pre-versus post pregnancy. Interval rate of change in RVESVi of PVR- exceeded PVR+ women (+3.7 ± 5.0 versus -2.2 ± 5.0 ml/m2/year, p = 0.03). Pregnancy outcomes did not differ in PVR+ versus PVR- women. CONCLUSIONS Pregnancy outcomes did not differ according to PVR status in our cohort. While RV volumes remained unchanged in PVR+ women, interval RV dilation was observed in PVR- women. Additional study of a larger population with longer follow-up may further inform clinical practice regarding pre-pregnancy PVR.
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Affiliation(s)
- Kenichiro Yamamura
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Valeria Duarte
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA
| | - Gauri Rani Karur
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Julia Graf
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA
| | - Kate Hanneman
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tal Geva
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA
| | - Anne Marie Valente
- Boston Children's Hospital, Department of Cardiology, Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Department of Medicine, Boston, MA, USA
| | - Rachel M Wald
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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10
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Buddeberg BS, Fernandes NL, Vorster A, Cupido BJ, Lombard CJ, Swanevelder JL, Girard T, Dyer RA. Cardiac Structure and Function in Morbidly Obese Parturients: An Echocardiographic Study. Anesth Analg 2020; 129:444-449. [PMID: 29878938 DOI: 10.1213/ane.0000000000003554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The increasing prevalence of obesity worldwide is a major threat to global health. Cardiac structural and functional changes are well documented for obesity as well as for pregnancy, but there is limited literature on morbidly obese parturients. We hypothesized that there are both cardiac structural and functional differences between morbidly obese pregnant women and pregnant women of normal body mass index (BMI). METHODS This prospective cross-sectional study was performed in 2 referral maternity units in Cape Town, South Africa, over a 3-month period. Forty morbidly obese pregnant women of BMI ≥40 kg·m (group O) were compared to 45 pregnant women of BMI ≤30 kg·m (group N). Cardiac structure and function were assessed by transthoracic echocardiography, according to the recommendations of the British Society of Echocardiography. The 2-sample t-test with unequal variances was used for the comparison of the mean values between the groups. RESULTS Acceptable echocardiographic images were obtained in all obese women. Statistical significance was defined as P < .0225 after applying the Benjamini-Hochberg correction for multiple testing. Mean (standard deviation) mean arterial pressure was higher in group O (91 [8.42] vs 84 [9.49] mm Hg, P < .001). There were no between-group differences in heart rate, stroke volume, or cardiac index (84 [12] vs 79 [13] beats·minute, P = .103; 64.4 [9.7] vs 59.5 [13.5] mL, P = .069; 2551 [474] vs 2729 [623] mL·minute·m, P = .156, for groups O and N, respectively). Stroke volume index was lower, and left ventricular mass was higher in group O (30.14 [4.51] vs 34.25 [7.00] mL·m, P = .003; 152 [24] vs 115 [29] g, P < .001). S' septal was lower in group O (8.43 [1.20] vs 9.25 [1.64] cm·second, P = .012). Considering diastolic function, isovolumetric relaxation time was significantly prolonged in group O (73 [15] vs 61 [15] milliseconds, P < .001). The septal tissue Doppler index E' septal was lower in group O (9.08 [1.69] vs 11.28 [3.18], P < .001). There were no between-group differences in E' average (10.7 [2.3] vs 12.0 [2.7], P = .018, O versus N) or E/E' average (7.85 [1.77] vs 7.27 [1.68], P = .137, O versus N). Right ventricular E'/A' was lower in group O (1.07 [0.47] vs 1.29 [0.32], P = .016). CONCLUSIONS Cardiac index did not differ between obese pregnant women and those with normal BMI. Their increased left ventricular mass and lower stroke volume index could indicate a limited adaptive reserve. Obese women had minor decreases in septal left ventricular tissue Doppler velocity, but the E/E' average values did not suggest clinically significant diastolic dysfunction.
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Affiliation(s)
- Bigna S Buddeberg
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.,Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
| | - Nicole L Fernandes
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Adri Vorster
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Blanche J Cupido
- Department of Cardiology, University of Cape Town and Groote Schuur Hospital, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
| | - Carl J Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Justiaan L Swanevelder
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Thierry Girard
- Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
| | - Robert A Dyer
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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O'Kelly AC, Sharma G, Vaught AJ, Zakaria S. The Use of Echocardiography and Advanced Cardiac Ultrasonography During Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:71. [PMID: 31754837 PMCID: PMC8015779 DOI: 10.1007/s11936-019-0785-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Pregnancy is a time of significant cardiovascular change. Echocardiography is the primary imaging modality used to assess cardiovascular anatomy and physiology during pregnancy. Both two-dimensional (2D) echocardiography and advanced cardiac ultrasound modalities play pivotal roles in identifying and monitoring these changes, especially in women with preexisting or new cardiac disease. This paper reviews the role of echocardiography and advanced cardiac ultrasound during normal pregnancy and pregnancy complicated by hypertensive disorders, valvular disorders, and cardiomyopathy. It also examines the role of echocardiography in guiding decisions about delivery. RECENT FINDINGS The data establishing normal echo parameters during pregnancy are inconsistent. In addition, there is limited research exploring the role of advanced cardiac ultrasound modalities, such as tissue Doppler imaging or speckle tracking echocardiography, in assessing cardiac function during pregnancy. What data there are suggest that these advanced modalities can be used to identify subclinical changes before traditional echocardiography can, and thus have clear utility in identifying early abnormal cardiac responses to pregnancy. Echocardiography is the modality of choice for imaging the heart in pregnant women. Advanced ultrasound modalities increasingly play a role in identifying abnormal adaptations to pregnancy and detecting subclinical changes. This, in turn, can help promote a healthy pregnancy for both mother and fetus.
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Affiliation(s)
- Anna C O'Kelly
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Ave. Bldg 301, Suite 2400, Baltimore, MD, 21224, USA
| | - Arthur Jason Vaught
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 660 North Wolfe Street, Phipps 228, Baltimore, MD, 21287, USA
| | - Sammy Zakaria
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Ave. Bldg 301, Suite 2400, Baltimore, MD, 21224, USA
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Romagano M, Louis-Jacques A, Quinones J, Freudenberger R, Fleming L, Smulian J, Martinez M. Is there a role for cardiac magnetic resonance imaging during pregnancy? J Matern Fetal Neonatal Med 2018; 33:558-563. [PMID: 29973095 DOI: 10.1080/14767058.2018.1497598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To assess the role of cardiac magnetic resonance imaging (CMR) for the evaluation and management of women with cardiac disorders in pregnancy and postpartum.Methods: Retrospective record review of women at a university-affiliated, single institution referred for CMR without contrast due to known or suspected cardiac disorders between January 2010 and December 2015. Medical records, echocardiogram and CMR reports were reviewed. Instances where clinical management was changed based on CMR findings were identified.Results: There were 17 peripartum CMR studies performed without contrast in 17 pregnancies from 16 women. Indications for CMR included congenital heart disease (N = 8, 47.1%), Marfan syndrome or strong family history of Marfan syndrome (N = 5, 29.4%), cardiomyopathy (N = 1, 5.9%), cardiac mass (N = 1, 5.9%), persistent dyspnea with a normal echocardiogram (N = 1, 5.9%), and hypertension with suspected aortic root dilation (N = 1, 5.9%). CMR confirmed the echocardiogram diagnosis in eight (47.1%) and improved the diagnosis in five (29.4%). Availability of CMR findings changed the delivery management in 2/17 (11.8%) women. CMR was especially helpful in assessing the size of the aortic root in women at risk for dilation.Conclusions: Although echocardiogram imaging of the heart is considered the first-line method for assessing the maternal cardiac status, CMR can provide information about cardiac anatomy and function in pregnant women with complex cardiac disease or suspected aortic pathology. Management may be changed based on results.
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Affiliation(s)
- Matthew Romagano
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Adetola Louis-Jacques
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Joanne Quinones
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Ronald Freudenberger
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Laurie Fleming
- Lehigh Magnetic Imaging Center, Lehigh Valley Health Network, Allentown, PA, USA
| | - John Smulian
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Matthew Martinez
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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McLaughlin K, Wright SP, Kingdom JC, Parker JD. Clinical Validation of Non-Invasive Cardiac Output Monitoring in Healthy Pregnant Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1008-1014. [DOI: 10.1016/j.jogc.2017.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 01/30/2023]
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De Robertis E, Borrelli V, Anfora R, Scibelli G, Piazza O, Romano GM. Choosing wisely in obstetric anesthesia: Reexamining our practice. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Aasa KL, Maciver RD, Ramchandani S, Adams MA, Ozolinš TRS. In UteroExposure to a Cardiac Teratogen Causes Reversible Deficits in Postnatal Cardiovascular Function, But Altered Adaptation to the Burden of Pregnancy. Toxicol Sci 2015; 148:155-66. [DOI: 10.1093/toxsci/kfv169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tara F, Vakilian F, Moosavi-Baigy F, Salehi M, Moghiman T. Prenatal and cardiovascular outcome in pregnant patients with dyspnea. Res Cardiovasc Med 2015; 4:e20950. [PMID: 25861584 PMCID: PMC4386424 DOI: 10.5812/cardiovascmed.20950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/10/2014] [Accepted: 11/05/2014] [Indexed: 11/28/2022] Open
Abstract
Background: Pregnancy is a physiologic phenomenon in women, which leads to significant hemodynamic changes in cardiovascular system. Many patients reach reproductive age due to improvements in diagnosis and treatment of cardiac diseases. Dyspnea is a common complaint in pregnant women and can be a sign to refer patients for an easy and feasible workup such as echocardiography. Objectives: We aimed to evaluate dyspnea as a common complaint in pregnant women and its prenatal outcome. Patients and Methods: Pregnant patients with dyspnea NYHA class > II were included. A thorough physical examination and routine lab tests were performed. Echocardiography was performed to rule out previous cardiac and lung diseases, anemia and thyroid disorders. It was repeated monthly till one month after delivery. Collected data was analyzed after one year. Results: Fifty patients were enrolled with a mean age of 30.49 ± 6.34 years. 58% of them, had NYHA class II, 40% III and 2% IV. Pulmonary rales were diagnosed in 8% and palpitation in 80%, while all had normal lab tests. Mean EF value was 52.26 ± 6.80; 54% had valvular diseases and 12% had pulmonary hypertension. Cesarean section was performed in 26, preeclampsia occurred in 7 and 21 had preterm labor. Three neonates had anomalies and six had an Apgar score below six. Mean birth weight was 2897 ± 540.00 grams. A significant association was found between NYHA Class with valvular disease (P = 0.007) and sys PAP (P = 0.036); however, it had an inverse correlation with LV EF (P = 0.06). Conclusions: Dyspnea may coincide with cardiac dysfunction and poor prenatal outcome in pregnant patients. In such cases echocardiography is a feasible screening tool.
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Affiliation(s)
- Fateme Tara
- Women Health Research Center, Omolbanin Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Farveh Vakilian
- Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Farveh Vakilian, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9153162670, Fax: +98-5118544504, E-mail:
| | | | - Maryam Salehi
- Community Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Toktam Moghiman
- Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Lima FV, Parikh PB, Zhu J, Yang J, Stergiopoulos K. Association of Cardiomyopathy With Adverse Cardiac Events in Pregnant Women at the Time of Delivery. JACC-HEART FAILURE 2015; 3:257-66. [DOI: 10.1016/j.jchf.2014.10.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
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Aasa KL, Zavan B, Luna RL, Wong PG, Ventura NM, Tse MY, Carmeliet P, Adams MA, Pang SC, Croy BA. Placental growth factor influences maternal cardiovascular adaptation to pregnancy in mice. Biol Reprod 2014; 92:44. [PMID: 25537372 DOI: 10.1095/biolreprod.114.124677] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In healthy human pregnancies, placental growth factor (PGF) concentrations rise in maternal plasma during early gestation, peak over Weeks 26-30, then decline. Because PGF in nongravid subjects participates in protection against and recovery from cardiac pathologies, we asked if PGF contributes to pregnancy-induced maternal cardiovascular adaptations. Cardiovascular function and structure were evaluated in virgin, pregnant, and postpartum C56BL/6-Pgf(-) (/) (-) (Pgf(-) (/) (-)) and C57BL/6-Pgf(+/+) (B6) mice using plethysmography, ultrasound, quantitative PCR, and cardiac and renal histology. Pgf(-/-) females had higher systolic blood pressure in early and late pregnancy but an extended, abnormal midpregnancy interval of depressed systolic pressure. Pgf(-/-) cardiac output was lower than gestation day (gd)-matched B6 after midpregnancy. While Pgf(-) (/) (-) left ventricular mass was greater than B6, only B6 showed the expected gestational gain in left ventricular mass. Expression of vasoactive genes in the left ventricle differed at gd8 with elevated Nos expression in Pgf(-) (/) (-) but not at gd14. By gd16, Pgf(-) (/) (-) kidneys were hypertrophic and had glomerular pathology. This study documents for the first time that PGF is associated with the systemic maternal cardiovascular adaptations to pregnancy.
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Affiliation(s)
- Kristiina L Aasa
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - Bruno Zavan
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada Department of Cell, Tissue and Developmental Biology, Federal University of Alfenas, Alfenas MG, Brazil
| | - Rayana L Luna
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada Federal University of Pernambuco - UFPE, Recife, Brazil
| | - Philip G Wong
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - Nicole M Ventura
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - M Yat Tse
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center, VIB, Leuven, Belgium Laboratory of Angiogenesis and Neurovascular Biology, Vesalius Research Center, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Michael A Adams
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - Stephen C Pang
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - B Anne Croy
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
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Abstract
There are multiple imaging modalities available for the assessment of pregnant women with known or suspected cardiac disease. Because of its safety and general availability, echocardiography is the preferred study of choice for the evaluation of ventricular function, valvular heart disease, congenital heart disease, evaluation of the aorta, and the estimation of cardiac hemodynamics in a pregnant patient. Cardiac MRI can be performed, especially for diseases of the aorta and complex congenital heart disease. Radiation exposure for the fetus and the mother will be discussed in the use of CT angiography, nuclear imaging, and left-heart catheterization including coronary angiography for specific indications in the pregnant woman. The use of exercise testing during pregnancy for functional assessment will be presented.
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Affiliation(s)
- Carol A Waksmonski
- Columbia University Medical Center, 630 West 168th St, New York, NY 10032.
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20
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Ducas RA, Elliott JE, Melnyk SF, Premecz S, daSilva M, Cleverley K, Wtorek P, Mackenzie GS, Helewa ME, Jassal DS. Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study. J Cardiovasc Magn Reson 2014; 16:1. [PMID: 24387349 PMCID: PMC3882291 DOI: 10.1186/1532-429x-16-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/11/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cardiovascular disease in pregnancy is the leading cause of maternal mortality in North America. Although transthoracic echocardiography (TTE) is the most widely used imaging modality for the assessment of cardiovascular function during pregnancy, little is known on the role of cardiovascular magnetic resonance (CMR). The objective of the Cardiac Hemodynamic Imaging and Remodeling in Pregnancy (CHIRP) study was to compare TTE and CMR in the non-invasive assessment of maternal cardiac remodeling during the peripartum period. METHODS Between 2010-2012, healthy pregnant women aged 18 to 35 years were prospectively enrolled. All women underwent TTE and CMR during the third trimester and at least 3 months postpartum (surrogate for non-pregnant state). RESULTS The study population included a total of 34 women (mean age 29 ± 3 years). During the third trimester, TTE and CMR demonstrated an increase in left ventricular end-diastolic volume from 95 ± 11 mL to 115 ± 14 mL and 98 ± 6 mL to 125 ± 5 mL, respectively (p<0.05). By TTE and CMR, there was also an increase in left ventricular (LV) mass during pregnancy from 111 ± 10 g to 163 ± 11 g and 121 ± 5 g to 179 ± 5 g, respectively (p<0.05). Although there was good correlation between both imaging modalities for LV mass, stroke volume, and cardiac output, the values were consistently underestimated by TTE. CONCLUSION This CMR study provides reference values for cardiac indices during normal pregnancy and the postpartum state.
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Affiliation(s)
- Robin A Ducas
- Section of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Rm Y3531, Bergen Cardiac Care Centre, St. Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
| | - Jason E Elliott
- Department of Obstetrics, Gynecology & Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Steven F Melnyk
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheena Premecz
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Megan daSilva
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelby Cleverley
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piotr Wtorek
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - G Scott Mackenzie
- Section of Cardiac Anesthesia, Department of Anesthesia, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael E Helewa
- Department of Obstetrics, Gynecology & Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Davinder S Jassal
- Section of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Rm Y3531, Bergen Cardiac Care Centre, St. Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
- Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Egidy Assenza G, Cassater D, Landzberg M, Geva T, Schreier J, Graham D, Volpe M, Barker N, Economy K, Valente AM. The effects of pregnancy on right ventricular remodeling in women with repaired tetralogy of Fallot. Int J Cardiol 2013; 168:1847-52. [DOI: 10.1016/j.ijcard.2012.12.071] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/03/2012] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
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Aasa KL, Kwong KK, Adams MA, Croy BA. Analysis of maternal and fetal cardiovascular systems during hyperglycemic pregnancy in the nonobese diabetic mouse. Biol Reprod 2013; 88:151. [PMID: 23636813 DOI: 10.1095/biolreprod.112.105759] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Preconception or gestationally induced diabetes increases morbidities and elevates long-term cardiovascular disease risks in women and their children. Spontaneously hyperglycemic (d)-NOD/ShiLtJ female mice, a type 1 diabetes model, develop bradycardia and hypotension after midpregnancy compared with normoglycemic, age- and gestational day (GD)-matched control (c-NOD) females. We hypothesized that onset of the placental circulation at GD 9-10 and rapid fetal growth from GD 14 correlate with aberrant hemodynamic outcomes in d-NOD females. To develop further gestational time-course correlations between maternal cardiac and renal parameters, high-frequency ultrasonography was applied to d- and c-NOD mice (virgin and at GD 8-16). Cardiac output and left ventricular (LV) mass increased in c-NOD but not in d-NOD mice. Ultrasound and postmortem histopathology showed overall greater LV dilation in d-NOD than in c-NOD mice at mid to late gestation. These changes suggest blunted remodeling and altered functional adaptation of d-NOD hearts. Umbilical cord ultrasounds revealed lower fetal heart rates from GD 12 and lower umbilical flow velocities at GD 14 and GD 16 in d-NOD versus c-NOD pregnancies. From GD 14 to GD 16, d-NOD fetal losses exceeded c-NOD fetal losses. Similar aberrant responses in pregnancies of women with diabetes may elevate postpartum maternal and child cardiovascular risk, particularly if mothers lack adequate prenatal care or have poor glycemic control during gestation.
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Affiliation(s)
- Kristiina L Aasa
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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Zhang J, Adams MA, Croy BA. Alterations in maternal and fetal heart functions accompany failed spiral arterial remodeling in pregnant mice. Am J Obstet Gynecol 2011; 205:485.e1-16. [PMID: 21831352 DOI: 10.1016/j.ajog.2011.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/29/2011] [Accepted: 06/02/2011] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Our goal was to define mechanisms that protect murine pregnancies deficient in spiral arterial remodeling from hypertension, hypoxia, and intrauterine growth restriction. STUDY DESIGN Microultrasound analyses were conducted on virgin, gestation day 2, 4, 7, 9, 10, 12, 14, 16, 18, and postpartum BALB/c (wild type) mice and BALB/c-Rag2(-/-)/Il2rg(-/-) mice, an immunodeficient strain lacking spiral arterial remodeling. RESULTS Rag2(-/-)/Il2rg(-/-) dams had normal spiral arterial flow velocities, greatly elevated uterine artery flow velocities between gestational day 10-16 and smaller areas of placental flow from gestational day 14 to term than controls. Maternal heart weight and output increased transiently. Conceptus alterations included higher flow velocities in the umbilical-placental circulation that became normal before term and bradycardia persistent to term. CONCLUSION Transient changes in maternal heart weight and function accompanied by fetal circulatory changes successfully compensate for deficient spiral arterial modification in mice. Similar compensations may contribute to the elevated risk for cardiovascular diseases seen in women and their children who experience preeclamptic pregnancies.
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Vitarelli A, Capotosto L. Role of echocardiography in the assessment and management of adult congenital heart disease in pregnancy. Int J Cardiovasc Imaging 2010; 27:843-57. [PMID: 21082254 DOI: 10.1007/s10554-010-9750-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/08/2010] [Indexed: 01/10/2023]
Abstract
Congenital heart disease represent a large proportion of heart disease in pregnancy. With the exception of patients with Eisenmenger's syndrome, pulmonary vascular obstructive disease, and Marfan's syndrome with aortopathy, maternal death during pregnancy is rare in women with CHD but morbidity occurs such as heart failure, arrhythmias, and stroke. Echocardiography represents a milestone in diagnosis, understanding of pathophysiology, assessment of disease severity and patient monitoring in pregnant women with unoperated and post-operative congenital heart disease.
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Affiliation(s)
- Antonio Vitarelli
- Echocardiology Unit, Cardiac Department, Sapienza University, Via Lima 35, 00198, Rome, Italy.
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