In women with mitral stenosis (MS), mitral valve gradients and right ventricular systolic
pressure (RVSP) can increase in response to the physiologic stress of pregnancy. The
prognostic significance of these echocardiographic changes has not been well studied.
Pregnancy outcomes and serial echocardiograms were collected in women with MS prospectively
recruited as part of a larger study on pregnancy outcomes. Third trimester echocardiograms
were compared with baseline echocardiograms. Changes in mitral valve area (MVA), transmitral
mean gradient (MG), and RVSP during pregnancy and their relationship to adverse cardiac
events (CE) were examined. Fifty-six pregnancies in 47 women with MS were included.
The MVA did not change during pregnancy (1.6 ± 0.6 cm2 at baseline vs 1.7 ± 0.6 cm2 in the third trimester, p = 0.46). There was an increase in the MG (8 ± 3 vs 11 ±
6 mm Hg, p <0.001) and the RVSP (39 ± 14 vs 47 ± 20 mm Hg, p <0.001) during the third
trimester. Adverse CE occurred in 45% (25/56) of pregnancies. CE were associated with
baseline MG>10 mm Hg, baseline RVSP >40 mm Hg, third-trimester MG>10 mm Hg, and RVSP
>40 mm Hg. Women with mitral valve MG ≤10 mm Hg who had a normal RVSP at baseline
and in the third trimester were at lowest risk for CE (11%) with a negative predictive
value of 89%. In conclusion, baseline echocardiographic assessment of MS severity
as well as changing echocardiographic parameters during pregnancy can help identify
women at risk for cardiac complications during pregnancy.
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Reference
- Physiologic changes during normal pregnancy and delivery.Cardiol Clin. 2012; 30: 317-329
- Cardiac disease in pregnancy I. Prospective multicenter study of pregnancy outcomes in women with heart disease.Circulation. 2001; 104: 515-521
- Pregnancy outcomes in women with heart disease: the CARPREG II study.J Am Coll Cardiol. 2018; 71: 2419-2430
- Pregnancy outcomes in women with significant valve disease: a systematic review and meta-analysis.Heart. 2020; 106: 512-519
- Cardiac risk in pregnant women with rheumatic mitral stenosis.Am J Cardiol. 2003; 91: 1382-1385
- Pregnancy outcomes in women with rheumatic mitral valve disease: results from the registry of pregnancy and cardiac disease.Circulation. 2018; 137: 806-816
- The effect of valvular heart disease on maternal and fetal outcome of pregnancy.J Am Coll Cardiol. 2001; 37: 893-899
- Echocardiographic assessment of cardiovascular hemodynamics in normal pregnancy.Obstet Gynecol. 2004; 104: 20-29
- Serial study of factors influencing changes in cardiac output during human pregnancy.Am J Physiol. 1989; 256: H1060-H1065
- Echocardiographic evaluation of hemodynamic changes in left-sided heart valves in pregnant women with valvular heart disease.Am J Cardiol. 2016; 118: 1046-1052
- Clinical and echocardiographic assessment of pregnant women with valvular heart diseases–maternal and fetal outcome.Int J Cardiol. 2004; 94: 15-23
- The role of exercise echocardiography in the management of mitral valve disease.Neth Heart J. 2013; 21: 487-496
- The emerging role of exercise testing and stress echocardiography in valvular heart disease.J Am Coll Cardiol. 2009; 54: 2251-2260
- Maternal cardiac output and fetal doppler predict adverse neonatal outcomes in pregnant women with heart disease.J Am Heart Assoc. 2015; 4 (e002414)
- Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.J Am Soc Echocardiogr. 2009; 22 (1-23; quiz): 101-102
- 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: 2440-2492
- ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association.Circulation. 2009; 119: 2250-2294
- Valvular heart disease and pregnancy.Cardiol Clin. 2012; 30: 369-381
- Valvular heart disease in pregnancy.Best Pract Res Clin Obstet Gynaecol. 2014; 28: 507-518
- 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy.Eur Heart J. 2018; 39: 3165-3241
- Valvular heart disease and pregnancy part I: native valves.J Am Coll Cardiol. 2005; 46: 223-230
- 2017 ESC/EACTS Guidelines for the management of valvular heart disease.Eur Heart J. 2017; 38: 2739-2791
- Dobutamine stress echocardiography for noninvasive assessment and risk stratification of patients with rheumatic mitral stenosis.J Am Coll Cardiol. 2004; 43: 393-401
- Valve stress echocardiography: a practical guide for referral, procedure, reporting, and clinical implementation of results from the HAVEC group.JACC Cardiovasc Imaging. 2015; 8: 724-736
- Impact of net atrioventricular compliance on clinical outcome in mitral stenosis.Circ Cardiovasc Imaging. 2013; 6: 1001-1008
- Impact of atrioventricular compliance on pulmonary artery pressure in mitral stenosis: an exercise echocardiographic study.Circulation. 2000; 102: 2378-2384
- Pulmonary hypertension due to left heart disease.Circulation. 2012; 126: 975-990
- American Society of E, European Association of E. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography.J Am Soc Echocardiogr. 2012; 25: 3-46
Article info
Publication history
Published online: September 08, 2021
Received in revised form:
July 26,
2021
Received:
April 9,
2021
Footnotes
This study was supported by a grant from the Allan E. Tiffin Trust (Toronto General & Western Hospital Foundation). Dr. Silversides is supported by the Miles Nadal chair in Pregnancy and Heart Disease (Mount Sinai Hospital).
All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
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© 2021 Published by Elsevier Inc.
