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Cardiac adaption during pregnancy in women with congenital heart disease and healthy women
  1. Marlies A M Kampman1,2,
  2. Mattia A E Valente1,
  3. Joost P van Melle1,
  4. Ali Balci3,
  5. Jolien W Roos-Hesselink4,
  6. Barbara J M Mulder5,
  7. A P J van Dijk6,
  8. M A Oudijk7,
  9. M R M Jongbloed8,
  10. Dirk J van Veldhuisen1,
  11. Petronella G Pieper1
  12. on behalf of the ZAHARA II investigators
  1. 1Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
  3. 3Department of Cardiology, Isala Clinic, Zwolle, The Netherlands
  4. 4Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
  5. 5Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  6. 6Department of Cardiology, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
  7. 7Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  8. 8Department of Cardiology, University Medical Center Leiden, University of Leiden, Leiden, The Netherlands
  1. Correspondence to Dr Petronella G Pieper, Department of cardiology, University Medical Centre Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands; p.g.pieper{at}umcg.nl

Abstract

Objective Pregnancy in women with congenital heart disease (CHD) is associated with deterioration in cardiac function. However, longitudinal data are scarce. This study describes serial changes in cardiac dimensions and function during pregnancy in women with CHD and compares these with healthy pregnant women (controls).

Methods Eight tertiary centres prospectively enrolled 125 pregnant women with CHD (pregnancy duration <20 weeks). Controls (N=49) were recruited from low-risk midwife practices. Standardised echocardiography at 20 and 32 weeks gestation and 1 year postpartum was performed.

Results Age and parity were comparable between both groups (p>0.1). Left ventricular ejection fraction (LVEF) <45% was present in 3.2% of women with CHD and 14.4% had tricuspid annular plane systolic excursion (TAPSE) <16 mm. Absolute values of ventricular function parameters and diameters were less favourable in women with CHD. No permanent changes occurred in right and left ventricular function parameters and dimensions in women with CHD. The patterns of change in cardiac function and dimensions were comparable between women with CHD and controls, except for LVEF (p=0.026). In women with right-sided CHD the pattern of TAPSE over time differed from controls (p=0.043) (no decrease in TAPSE postpregnancy in CHD). In women with left-sided CHD left ventricular end-diastolic diameter (LVEDD) tended to increase compared with controls (p=0.045).

Conclusions Absolute levels of ventricular function parameters and diameters differ between CHD and controls, but changes during and after pregnancy are generally comparable. However, different patterns over time seen for TAPSE and LVEDD in women with right-sided and left-sided CHD, respectively, compared with controls indicate the importance of echocardiographic follow-up during pregnancy in women with CHD.

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