Current Cardiology Reports

, Volume 12, Issue 3, pp 250–256 | Cite as

Cardiac Disease in Pregnancy: Value of Echocardiography

Article

Abstract

Cardiovascular disease in women during pregnancy poses particular challenges. It continues to be a leading cause of maternal mortality and contributes to significant morbidity. Echocardiography is essential in characterizing the extent and effects of heart disease prior to, during, and after pregnancy. By understanding the physiologic adaptation in pregnancy with increases in heart rate, blood volume, and cardiac output, and decrease in vascular resistance, one can anticipate and recognize the effects of these changes on various cardiac lesions. Cardiomyopathy, severe, obstructive valvular disease, aortic dilation due to Marfan’s disease, and cyanotic congenital heart disease are poorly tolerated in pregnancy. These disorders can be readily distinguished from normal structural changes of pregnancy and their severity assessed by echocardiography. Cardiovascular disease in women of reproductive age requires careful, multidisciplinary management by obstetric and medical teams ideally beginning preconception and continuing through the postpartum period.

Keywords

Echocardiography Pregnancy Cardiac disease 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as follows: • Of importance •• Of major importance

  1. 1.
    Task Force on the Management of Cardiovascular Diseases During Pregnancy of the European Society of Cardiology: Expert consensus document on management of cardiovascular diseases during pregnancy. Eur Heart J 2003, 24:761–781.Google Scholar
  2. 2.
    Lund CJ, Donovan JC: Blood volume during pregnancy. Significance of plasma and red cell volumes. Am J Obstet Gynecol 1967, 98:394–403.PubMedGoogle Scholar
  3. 3.
    Poppas A, Shroff SG, Korcarz CE, et al.: Serial assessment of the cardiovascular system in normal pregnancy. Role of arterial compliance and pulsatile arterial load. Circulation 1997, 95:2407–2415.PubMedGoogle Scholar
  4. 4.
    Gilson GJ, Samaan S, Crawford MH, et al.: Changes in hemodynamics, ventricular remodeling, and ventricular contractility during normal pregnancy: a longitudinal study. Obstet Gynecol 1997, 89:957–962.CrossRefPubMedGoogle Scholar
  5. 5.
    Robson SC, Hunter S, Boys RJ, Dunlop W: Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol 1989, 256:H1060–H1065.PubMedGoogle Scholar
  6. 6.
    Duvekot JJ, Cheriex EC, Pieters FA, et al.: Early pregnancy changes in hemodynamics and volume homeostasis are consecutive adjustments triggered by a primary fall in systemic vascular tone. Am J Obstet Gynecol 1993, 169:1382–1392.PubMedGoogle Scholar
  7. 7.
    Katz R, Karliner JS, Resnik R: Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation 1978, 58:434–441.PubMedGoogle Scholar
  8. 8.
    Capeless EL, Clapp JF: When do cardiovascular parameters return to their preconception values? Am J Obstet Gynecol 1991, 165:883–886.PubMedGoogle Scholar
  9. 9.
    Eghbali M, Deva R, Alioua A et al.: Molecular and functional signature of heart hypertrophy during pregnancy. Circ Res 2005, 96:1208–1216.CrossRefPubMedGoogle Scholar
  10. 10.
    Simmons LA, Gillin AG, Jeremy RW: Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Am J Physiol Heart Circ Physiol 2002, 283:H1627–H1633.PubMedGoogle Scholar
  11. 11.
    Mone SM, Sanders SP, Colan SD: Control mechanisms for physiological hypertrophy of pregnancy. Circulation 1996, 94:667–672.PubMedGoogle Scholar
  12. 12.
    Fok WY, Chan LY, Wong JT, et al.: Left ventricular diastolic function during normal pregnancy: assessment by spectral tissue Doppler imaging. Ultrasound Obstet Gynecol 2006, 28:789–793.CrossRefPubMedGoogle Scholar
  13. 13.
    Mesa A, Jessurun C, Hernandez A, et al.: Left ventricular diastolic function in normal human pregnancy. Circulation 1999, 99:511–517.PubMedGoogle Scholar
  14. 14.
    • Bamfo JE, Kametas NA, Nicolaides KH, Chambers JB: Reference ranges for tissue Doppler measures of maternal systolic and diastolic left ventricular function. Ultrasound Obstet Gynecol 2007, 29:414–420. This well-done study provides normative values to use when assessing ventricular systolic and diastolic function in pregnancy.Google Scholar
  15. 15.
    Campos O, Andrade JL, Bocanegra J, et al.: Physiologic multivalvular regurgitation during pregnancy: a longitudinal Doppler echocardiographic study. Int J Cardiol 1993, 40:265–272.CrossRefPubMedGoogle Scholar
  16. 16.
    Abduljabbar HS, Marzouki KM, Zawawi TH, Khan AS: Pericardial effusion in normal pregnant women. Acta Obstet Gynecol Scand 1991, 70:291–294.CrossRefPubMedGoogle Scholar
  17. 17.
    Ristic AD, Seferovic PM, Ljubic A, et al.: Pericardial disease in pregnancy. Herz 2003, 28:209–215.CrossRefPubMedGoogle Scholar
  18. 18.
    Hibbard JU, Lindheimer M, Lang RM: A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography. Obstet Gynecol 1999, 94:311–316.CrossRefPubMedGoogle Scholar
  19. 19.
    Pearson GD, Veille JC, Rahimtoola S, et al.: Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000, 283:1183–1188.CrossRefPubMedGoogle Scholar
  20. 20.
    Elkayam U, Akhter MW, Singh H, et al.: Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation 2005, 111:2050–2055.CrossRefPubMedGoogle Scholar
  21. 21.
    Amos AM, Jaber WA, Russell SD: Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J 2006, 152:509–513.CrossRefPubMedGoogle Scholar
  22. 22.
    Chapa JB, Heiberger HB, Weinert L, et al.: Prognostic value of echocardiography in peripartum cardiomyopathy. Obstet Gynecol 2005, 105:1303–1308.PubMedGoogle Scholar
  23. 23.
    •• Habli M, O’Brien T, Nowack E, et al.: Peripartum cardiomyopathy: prognostic factors for long-term maternal outcome. Am J Obstet Gynecol 2008, 199:415.e1–415.e5. This recent, large case series of patients with PPCM provides updated morbidity and mortality data that can be used to assess patients and prognosticate.Google Scholar
  24. 24.
    Duran N, Gunes H, Duran I, et al.: Predictors of prognosis in patients with peripartum cardiomyopathy. Int J Gynaecol Obstet 2008, 101:137–140.CrossRefPubMedGoogle Scholar
  25. 25.
    Elkayam U, Tummala PP, Rao K, et al.: Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med 2001, 344:1567–1571.CrossRefPubMedGoogle Scholar
  26. 26.
    Dorbala S, Brozena S, Zeb S, et al.: Risk stratification of women with peripartum cardiomyopathy at initial presentation: a dobutamine stress echocardiography study. J Am Soc Echocardiogr 2005, 18:45–48.CrossRefPubMedGoogle Scholar
  27. 27.
    Lampert MB, Weinert L, Hibbard J, et al.: Contractile reserve in patients with peripartum cardiomyopathy and recovered left ventricular function. Am J Obstet Gynecol 1997, 176:189–195.CrossRefPubMedGoogle Scholar
  28. 28.
    Tsiaras S, Poppas A: Mitral valve disease in pregnancy: outcomes and management. Obstet Med 2009, 2:6–10.CrossRefGoogle Scholar
  29. 29.
    Rokey R, Hsu HW, Moise KJJ, et al.: Inaccurate noninvasive mitral valve area calculation during pregnancy. Obstet Gynecol 1994, 84:950–955.PubMedGoogle Scholar
  30. 30.
    Esteves CA, Munoz JS, Braga S, et al.: Immediate and long-term follow-up of percutaneous balloon mitral valvuloplasty in pregnant patients with rheumatic mitral stenosis. Am J Cardiol 2006, 98:812–816.CrossRefPubMedGoogle Scholar
  31. 31.
    Abascal VM, Wilkins GT, O’Shea JP, et al.: Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation 1990, 82:448–456.PubMedGoogle Scholar
  32. 32.
    Stoddard MF, Longaker RA, Vuocolo LM, Dawkins PR: Transesophageal echocardiography in the pregnant patient. Am Heart J 1992, 124:785–787.CrossRefPubMedGoogle Scholar
  33. 33.
    Lesniak-Sobelga A, Tracz W, KostKiewicz M, et al.: Clinical and echocardiographic assessment of pregnant women with valvular heart diseases—maternal and fetal outcome. Int J Cardiol 2004, 94:15–23.CrossRefPubMedGoogle Scholar
  34. 34.
    Bonow RO, Carabello BA, Chatterjee K, et al.: ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006, 48:e1–e148.CrossRefPubMedGoogle Scholar
  35. 35.
    Chan WS, Anand S, Ginsberg JS: Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med 2000, 160:191–196.CrossRefPubMedGoogle Scholar
  36. 36.
    Goland S, Barakat M, Khatri N, Elkayam U: Pregnancy in Marfan syndrome: maternal and fetal risk and recommendations for patient assessment and management. Cardiol Rev 2009, 17:253–262.CrossRefPubMedGoogle Scholar
  37. 37.
    Weiss BM, Zemp L, Seifert B, Hess OM: Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol 1998, 31:1650–1657.CrossRefPubMedGoogle Scholar
  38. 38.
    Weiss BM, Hess OM: Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives. Eur Heart J 2000, 21:104–115.CrossRefPubMedGoogle Scholar
  39. 39.
    •• Drenthen W, Pieper PG, Roos-Hesselink JW, et al.: Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007, 49:2303–2311. This well-researched and well-written state-of-the-art paper presents the compilation of published reports in clear and accessible tables to help assess individual maternal and fetal risk in pregnancy complicated by heart disease.Google Scholar
  40. 40.
    Siu SC, Sermer M, Colman JM, et al.: Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001, 104:515–521.CrossRefPubMedGoogle Scholar
  41. 41.
    Elkayam U, Bitar F: Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol 2005, 46:223–230.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Echocardiography LaboratoryRhode Island Hospital/Brown Medical SchoolProvidenceUSA

Personalised recommendations