Left Ventricular Performance During Pregnancy in Patients With Repaired Tetralogy of Fallot-Prospective Evaluation Using the Tei Index-

Abstract

Little is known about the influence of hemodynamic changes on ventricular performance during pregnancy in patients with congenital heart disease. A prospective evaluation was made of 17 pregnancies in 11 women with repaired tetralogy of Fallot (ToF). Twenty age-matched non-pregnant women and 41 stable pregnant women without heart disease were studied as controls. Blood pressure (BP), heart rate (HR), left ventricular end-diastolic dimension (LVEDD) and ejection fraction (LVEF), and the Tei index were measured before pregnancy; during the 1st, 2nd, and 3rd trimesters; and after delivery. BP and HR gradually increased during the pregnancy in both groups. The LVEDD in the controls increased throughout the gestation period, then decreased after delivery. In contrast, the LVEDD in the ToF was significantly smaller than that of the controls, and no such increase was observed. The LVEF did not change throughout pregnancy or after the delivery in either group. Although the Tei index of the controls did not change throughout the pregnancy, in the ToF group it was significantly increased in the 2nd and 3rd trimester and then decreased after delivery. These findings suggest that subclinical left ventricular intolerance for volume overload, probably because of the smaller LVEDD, may exist during pregnancy in patients with a repaired ToF.

Prediction of Prognosis in the UM-X7.1 Hamster Model of Congestive Heart Failure Using the Tei Index

“…In addition, the Tei index closely correlates with patient prognosis, 2-5,13 hemodynamics, [14][15][16] and others. [17][18][19][20][21][22] The present study confirmed these previous findings and further demonstrated the usefulness of the Tei index in the UM-X7.1 hamster model of CHF.…”

Chest x rays illustrating successful resynchronisation therapy

“…Several reports have described a total of 68 pregnancies in patients with a corrected tetralogy of Fallot. [10][11][12][13][14] No complications were reported in these 68 pregnancies, in contrast to our series.…”

Maternal cardiac and obstetric performance in consecutive pregnancies in women with heart disease

“…Several studies have shown long-term deleterious effects of pregnancy on the heart in women with some cardiac lesions [5][6][7] and late cardiac events have been shown to be more common in women who had a cardiac event in pregnancy. 4 We hypothesised that there would be more cardiac complications in second pregnancies than first, but we found a similar incidence.…”

“…Most recent data focus on maternal outcomes during pregnancy, but the impact of the prolonged haemodynamic stress of pregnancy beyond the puerperium is not clear. Late cardiac events in women with heart disease following pregnancy appear to be associated with cardiac events during pregnancy, suggesting that cardiac decompensation during pregnancy in women with heart disease may not be reversible 4 Indeed, data also suggest that pregnancy has an irreversible deleterious effect on ventricular function in women with tetralogy of Fallot 5,6 and a systemic right ventricle. 7 It would seem likely that in women with heart disease, increasing parity might place an additional burden on the already compromised heart, thereby affecting pregnancy outcomes.…”