Doppler Echocardiography During Pregnancy

Abstract

Despite continuous improvements in diagnostic cardiology techniques, echocardiography remains the cornerstone for noninvasive cardiovascular assessment of the pregnant woman with heart disease or suspected cardiac abnormality. Reversible physiological cardiac remodeling of pregnancy associated with changes in valve patency or transvalvular flow pattern can be suitably assessed by the complementary use of quantitative pulsed- and continuous Doppler and qualitative color Doppler technology. These techniques are also useful for a better understanding of the pathophysiology of the hemodynamic consequences of fixed valve stenosis during pregnancy with respect to the labile nature of gradients resulting from variable loading conditions as occurs during pregnancy. Recent and specific areas of clinical use including cardiac output estimation, contrast echocardiography minimizing radioscopy during cardiac catheterization, and transesophageal echocardiography for selection of patients with mitral stenosis suitable for percutaneous catheter valvotomy illustrate the large spectrum of capabilities of this versatile method during pregnancy. (ECHOCARDIOGRAPHY, Volume 13, March 1996)

Cardiovascular magnetic resonance in pregnancy: Insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study

“…Whereas quantitative assessment of the RV using TTE is difficult due to its complex geometry, CMR serves as the gold standard for non-invasive assessment of this chamber due to its higher spatial resolution and low intra- and inter-observer variability [42]. A previous study using TTE demonstrated an increase in RVEDD by 18% during the third trimester [17], which is very similar to the values obtained in our study. Using CMR in our study, we also provide new reference values for an increase in RV volume and mass with preserved RV systolic function during pregnancy.…”

“…Similar to previous studies that demonstrated an increase in LA volumes by approximately 30% in the third trimester [10,14,43], our study confirmed LA volume increases of 39% and 50% by TTE and CMR, respectively. Although few studies have examined RA volumes during pregnancy, Campos et al demonstrated a 19% increase in RA dimensions in the third trimester by TTE [17]. Our study demonstrated an increase in RA volume of 34% and 55% by TTE and CMR, respectively.…”

“…Without a clear understanding of what is considered normal, diagnosis of disease is challenging, if not impossible. While normal standards of maternal cardiac structure and function are well established for TTE, based on studies conducted since the 1960’s [10-15,17,18,20,41-47] this is the first study to longitudinally assess normal changes in maternal cardiac function and structure during pregnancy using both TTE and CMR. In the current study, we demonstrated an increase in chamber dimensions, LV mass, SV, and CO by both imaging modalities, with tighter confidence intervals using CMR.…”

“…The combination of decreased left ventricular (LV) afterload, increased preload, and a concomitant increase in resting heart rate leads to an increase in cardiac output (CO) over the same period [4,9-16]. Varying degrees and patterns of secondary atrial enlargement and ventricular hypertrophy have been described during pregnancy, along with increases in the cross-sectional areas of the mitral, pulmonic, and tricuspid valves [17]. In the postpartum period, the physiologic adaptations of pregnancy undergo reversal to their pre-pregnant state, mostly occurring shortly after delivery [15].…”

The Treatment of Hypertension During Pregnancy: When Should Blood Pressure Medications Be Started?

“…Studies conducted in normal pregnancy demonstrate an increase in the size of all cardiac chambers, which decline to pre-pregnancy levels after delivery [54]. This is associated with eccentric hypertrophy, and a decrease in LV systolic strain, but stroke volume and stroke work increase, suggesting that the physiologic increase in cardiac output is partly maintained by the increase in chamber dimensions [55].…”