title: Hemodynamic adaptation to pregnancy in women with structural heart disease.
abstract: BACKGROUND
  Many women with structural heart disease reach reproductive age and contemplate motherhood. Pregnancy induces and requires major hemodynamic changes. Pregnant women with structural heart disease may have a reduced cardiac reserve. There are no longitudinal data on cardiovascular adaptation throughout pregnancy in women with structural heart disease.
  
  
  METHODS
  Thirty-five women with structural heart disease were included in a prospective observational trial. Maternal hemodynamics were assessed before conception, during pregnancy and 6 months postpartum by transthoracic echocardiography. Uteroplacental perfusion was analyzed by obstetric Dopplers. Longitudinal evolution over time was analyzed as well as the long term influence of pregnancy on cardiac function.
  
  
  RESULTS
  Cardiac output (CO), stroke volume (SV), left ventricular mass (LV mass) and E/E' ratio significantly increased and ejection fraction (EF) and fractional shortening (FS) decreased during pregnancy. There was a statistically significant difference in EF, FS and E/E' ratio before and after pregnancy.
  
  
  CONCLUSIONS
  The characteristic pattern of hemodynamic adaptation to pregnancy is attenuated in women with structural heart disease. The pregnancy related volume load induces progression of diastolic dysfunction. Our data suggest a persistent reduction in systolic and diastolic cardiac functions after pregnancy in women with structural heart disease.
authors.affiliation: Department of Obstetrics & Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: j.cornette@erasmusmc.nl.
authors.forename: J
authors.initials: J
authors.lastname: Cornette
authors.forename: T P E
authors.initials: TP
authors.lastname: Ruys
authors.forename: A
authors.initials: A
authors.lastname: Rossi
authors.forename: D
authors.initials: D
authors.lastname: Rizopoulos
authors.forename: J J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.forename: Y
authors.initials: Y
authors.lastname: Karamermer
authors.forename: P
authors.initials: P
authors.lastname: Opić
authors.forename: A E
authors.initials: AE
authors.lastname: Van den Bosch
authors.forename: M L
authors.initials: ML
authors.lastname: Geleijnse
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.forename: E A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: J W
authors.initials: JW
authors.lastname: Roos-Hesselink
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000328:Adult; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D055815:Young Adult