ABSTRACT
Background: The aim of our study was to characterize
echocardiographic changes during pregnancy in women with known LVOT
obstruction or AS compared to the healthy pregnancy controls, and to
assess the relationship with pregnancy outcomes.
Methods: We retrospectively studied 34 pregnant patients with
congenital LVOT obstruction or AS with healthy age-matched pregnant
controls. Patients with other significant valvular lesions, structural
heart disease (LVEF <40%), or prior valve surgery were
excluded. All LVOTO/AS patients underwent a minimum of 2 consecutive
echocardiograms between 1 year pre-conception up to 1 year postpartum,
with at least 2 studies during the pregnancy. Comprehensive
echocardiographic evaluation was performed including speckle-tracking LV
global longitudinal strain.
Results: A total of 83 echocardiograms from the study group and
34 echocardiograms from the control group were evaluated. Over the range
of LVOTO/AS, a significantly greater increase in the AV gradients and LV
and LA volumes were observed as compared with the controls. In the
sub-group of LVOTO/AS pregnant women with > moderate
(n=8) vs. <moderate LVOTO/AS (n=26), averaged
2nd/3rd trimester LVEF was lower
(51(12)% vs. 58(4)%, p=0.02) and GLS was lower (-19.5(2.8) vs.
-21.2(2.4), p=0.06). Pregnancy was well tolerated despite these changes.
Conclusion: Among pregnant women with even milder forms of
LVOTO/AS, increases in cardiac volumes and AV gradients can be expected
over the course of pregnancy. Significant decreases in LV function and
mechanics were only observed in women with moderate or greater LVOTO/AS,
although still remained in normal range.
Keywords: Speckle tracking echocardiography, global
longitudinal strain, left ventricular outflow tract obstruction, aortic
stenosis, pregnancy.