Echocardiography in Pregnancy: Part 1

Abstract

The prevalence of pregnant women with cardiovascular heart disease is increasing. Transthoracic echocardiography is safe during pregnancy, and it is an important diagnostic tool in pregnant women with established heart disease in order to monitor ventricular and valvular anatomy and function. In addition, it can be used to delineate cardiac anatomy in complex congenital heart disease and help stratify maternal risk during pregnancy. This review will focus on the use of echocardiography in the diagnosis and management of pregnant women with common congenital lesions and with prosthetic valves.

Echocardiographic Techniques of Deformation Imaging in the Evaluation of Maternal Cardiovascular System in Patients with Complicated Pregnancies

“…In industrialized countries, congenital heart diseases account for 75–82% of CVD in pregnancy, with shunt lesions predominating (20–65%), whereas in nonindustrialized countries the major cause is rheumatic valvular disease (56–89% of CVD in pregnancy). Finally, cardiomyopathies are rare, but they may potentially cause severe complications, and peripartum cardiomyopathy is the most common of them [ 2 ].…”

“…However, we know that it decreases rapidly in the first 2 weeks after the delivery, until 24 weeks postpartum. The increase in cardiac output seems to be due to increased stroke volume during early gestation, to increased heart rate later on [ 2 – 4 ]. Immediately after delivery, cardiac output further increases because of the decompression of the inferior vena cava and autotransfusion from the uterus.…”

“…Blood pressure typically decreases during normal gestation and it is usually 10 mmHg below baseline values in the second trimester. There is no agreement about systolic blood pressure change during pregnancy [ 2 – 8 ], but it appears likely that both diastolic and mean arterial blood pressure decrease from the early first trimester until 26–28 weeks and then they rise again towards the end of the pregnancy [ 3 , 7 – 9 ]. Blood pressure changes are induced by a reduction in systemic vascular resistance [ 10 ].…”

“…Vascular resistance decreases in the early first trimester, presents its nadir in the middle of the second trimester, and returns close to prepregnancy levels within two weeks after delivery [ 11 ]. Associated with the decrease of vascular resistance, there is an increase in global arterial compliance (approximately 30%), which is the pulsatile component of ventricular afterload [ 2 , 3 ]. The abovementioned hemodynamic changes can be considered the pathophysiological bases of cardiac remodeling during pregnancy [ 2 , 12 ].…”

“…Associated with the decrease of vascular resistance, there is an increase in global arterial compliance (approximately 30%), which is the pulsatile component of ventricular afterload [ 2 , 3 ]. The abovementioned hemodynamic changes can be considered the pathophysiological bases of cardiac remodeling during pregnancy [ 2 , 12 ]. In fact, a 15% increase of left atrial diameter has been related to the increase in preload.…”