Effect of pregnancy on clinical status and ventricular function in women with heart disease.
BACKGROUND
Pregnant women with heart disease (HD) are at an increased risk for maternal and neonatal adverse events. However, the effect of pregnancy on clinical status and ventricular function in women with HD has not been examined in a controlled study.


RESULTS
Ninety-three women with HD were studied longitudinally. Of these, fifty-three underwent clinical and echocardiographic evaluation before and 1.5+/-1.1 years after pregnancy (pregnancy group), whereas forty served as controls matched for age (28.6+/-4.6 versus 28.5+/-6.6, p=0.88), diagnosis, and length of follow-up (2.9+/-1.4 versus 2.6+/-1.1, p=0.23). NYHA functional class remained unchanged in both groups during follow-up. End diastolic and end systolic dimensions and shortening fraction of the morphologic left ventricle also remained unchanged. Furthermore, systemic and subpulmonary ventricular function remained unchanged in the pregnancy and control groups on semiquantitative analysis. Pregnancy, however, was associated with a persisting increase in subpulmonary ventricular size in patients with tetralogy of Fallot (ToF) which was not present in tetralogy controls. Furthermore, diagnosis of ToF was the only predictor of an increase in subpulmonary ventricular size after pregnancy on univariate logistic regression analysis (OR 8.8[95% CI 1.9-41.1], p=0.006).


CONCLUSIONS
In this longitudinal controlled study amongst women with HD no deleterious midterm effects of pregnancy on clinical status and right and left ventricular function were found. However, pregnancy was associated with a persisting increase in subpulmonary ventricular size, attributable to patients with repaired ToF. This may have prognostic implications and merits further investigation.
Adult Congenital Heart Disease Unit, Royal Brompton and Harefield NHS Trust, and the National Heart and Lung Institute at Imperial College, London SW3 6NP, UK. uebing@pedcard.uni-kiel.de
Anselm
A
Uebing
Panagiotis
P
Arvanitis
Wei
W
Li
Gerhard Paul
GP
Diller
Sonya V
SV
Babu-Narayan
Darlington
D
Okonko
Evdokia
E
Koltsida
Michael
M
Papadopoulos
Mark R
MR
Johnson
Martin G
MG
Lupton
Steve M
SM
Yentis
Philip J
PJ
Steer
Michael A
MA
Gatzoulis
D000328:Adult; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult