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Impact of Pregnancy on Ventricular Strain in Women with Repaired Tetralogy of Fallot

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Abstract

Increasing numbers of women with repaired tetralogy of Fallot (rTOF) are reaching reproductive age and seek counseling regarding their cardiovascular risks related to pregnancy. Therefore, the aim of this study was to characterize changes in left ventricular (LV) strain in women with rTOF during pregnancy and in the postpartum period. Seventeen pregnancies in women with rTOF were included (mean age at repair = 3.2 years ± 5.5 years; mean age at delivery = 32.7 ± 4 years). Echocardiograms from three time periods were analyzed; baseline (prior to conception or in the first trimester), third trimester, and 4–6 weeks postpartum. Sixty-five percent of the patients had at least mild pulmonary regurgitation. Eight patients (47%) had undergone at least one pulmonary valve replacement. There were no changes in LV ejection fraction (EF) or circumferential strain across the three time periods. Significant differences were present in longitudinal strain within the three time points (p = 0.01). Postpartum strain decreased in magnitude compared to the third trimester value (− 17.7 ± 4.1 vs. − 21 ± 5, p-value = 0.003) but was not different when compared to baseline strain (− 17.7 ± 4.1 vs. − 19.4 ± 3.4; p-value = 0.15). In conclusion, in women with rTOF, changes in longitudinal strain were observed during pregnancy with a return to baseline after delivery; EF did not change. These findings provide evidence that pregnancy does not adversely impact LV mechanics in the short term in this potentially vulnerable patient population.

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Acknowledgements

The STORCC team members include Laith Alshawabkeh, MD; Gabriele Egidy-Assenza, MD; Yoni Buber, MD; Nancy Barker, MS, PA-C; Jean Marie Carabuena, MD; Emily Dollar, BS; Sarah Rae Easter, MD; Michelle Gurvitz, MD; Daniel Halpern, MD; Amy J. Harmon, Psy.D; Kelsey Hickey, BA; Jenna S. Hynes, MD; Caitlyn Joyce, PA-C; Michael J. Landzberg, MD; Roisin B. Morgan, MD; Mary P. Mullen, MD; Patrick O’Gara, MD; Alexander R. Opotowsky, MD; Sarah Partington, MD; Dorothy Pearson, PA-C; Saraubh Rajpal, MD; Carrie Rouse, MD; Zöe Schefter, BS; Keri Shafer, MD; Michael N. Singh, MD; Shailendra Upadhyay, MD; Fred Wu, MD.

Funding

The STORCC initiative is supported by the Brigham and Women’s Hospital Watkins Discovery Award, the Barton and Weinberg Family Fund, the Connors Center for Women, the Boston Adult Congenital Heart Disease Program Dunlevie Fund, and the Sarah M. Liamos Fund for Adult Congenital Heart Disease Research.

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  1. Anne Marie Valente and David M. Harrild have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    Valeria E. Duarte, Julia A. Graf, Kimberlee Gauvreau, Sheila C. Drakeley, Matthew R. Carazo, Anne Marie Valente & David M. Harrild

  2. Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Valeria E. Duarte, Matthew R. Carazo & Anne Marie Valente

  3. Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Valeria E. Duarte

  4. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sarah Rae Easter & Katherine E. Economy

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  1. Valeria E. Duarte
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Correspondence to Anne Marie Valente.

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Duarte, V.E., Graf, J.A., Gauvreau, K. et al. Impact of Pregnancy on Ventricular Strain in Women with Repaired Tetralogy of Fallot. Pediatr Cardiol 41, 1795–1799 (2020). https://doi.org/10.1007/s00246-020-02447-3

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  • DOI: https://doi.org/10.1007/s00246-020-02447-3

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