Does the right ventricle experiment morphologic and functional changes similarly to the left ventricle during pregnancy?

Abstract

ObjectiveMorphological and functional right ventricular (RV) changes during normal pregnancy remain poorly characterized. Similar to left ventricle, RV load and function are expected to change, and establishing reference values for RV during a healthy pregnancy is critical for the evaluation of pregnancy‐related heart disease. The aim of the study was to describe RV adaptation in a prospective cohort.MethodsSerial echocardiographic examinations were performed in second trimester (24 ± 2 weeks), third (32 ± 2 week) trimester, and postpartum (>3 months after delivery). Nulliparous women were evaluated as control group. RV linear dimensions, areas, and function were assessed and compared.ResultsForty‐three pregnant women were evaluated and compared with nineteen nulliparous women as control. Function parameters decreased along gestation. RV fractional area fell from second to third trimester (52.01 ± 0.92 vs 48.73 ± 0.97, P < .05), as well as tricuspid annular plane systolic excursion (2.62 ± 0.05 vs 2.41 ± 0.05, P < .05); however, RV longitudinal strain (L) decreased earlier, showing main changes from second trimester (26.17 ± 0.86 vs 22.71 ± 0.57, P < .003, control vs second trimester). S′‐wave velocity followed a different pattern without changes during pregnancy. RV diameters significantly increased during pregnancy: basal (3.65 ± 0.06 vs 3.90 ± 0.06, P < .05), mid‐ (2.70 ± 0.06 vs 3.00 ± 0.07, P < .05), longitudinal (6.90 ± 0.09 vs 7.32 ± 0.11, P < .05), and right ventricle outflow tract proximal diameter (3.20 ± 0.06 vs 3.44 ± 0.06, P < .05). RV areas also suffered early variation during pregnancy. In postpartum evaluation, all these changes were reversed.ConclusionDuring pregnancy, RV experiments important variations. RV size increases, and its function decreases. Changes in LS were earlier compared with other function measures.

Left ventricular assist device in pregnancy: Case report and review of the literature

“…Furthermore, once a patient requires biventricular support, 1‐year survival drops to less than 50% 9 . Given that the workload of the right ventricle steadily increases throughout pregnancy, from a maternal aspect, a late pre‐term delivery would arguably result in a better maternal outcome based on the premise that delivery would allow for a quicker return to baseline hemodynamic function and remove the sustained strain from pregnancy 10 . The patient's neonatology team quoted around an approximately 1% potential rate of serious neonatal morbidity (necrotizing enterocolitis, severe respiratory distress syndrome, chronic lung disease, intraventricular hemorrhage, or cerebral palsy) at 34 weeks gestation.…”

Modeling renal autoregulation in a hemodynamic, first‐trimester gestational model

“…The hemodynamic changes that occur during the first trimester of pregnancy are taken into account in this model. These include increased starting volume and increased volumes of RA, RV, LA, LV, and the compartments belonging to the kidneys and uterus as compared to the non‐pregnant condition (Cheung & Lafayette, 2013; Del Prado et al, 2020; Sanghavi & Rutherford, 2014; Song et al, 2015). Model parameters are based on prior studies (BioGears, 2018; Goodwin et al, 2004; van Meurs & Antonius, 2018) and were adjusted to reach gestational values.…”

Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society

“…Data on right ventricular function in pregnancy are limited to a few small studies. GLS and fractional area change have been shown to decline to low normal as pregnancy progresses [ 26 ] but tissue Doppler imaging (TDI) peak Sʹ velocity has been shown not to change; all return to normal postpartum [ 26 ].…”