Objective
The number of adult congenital heart disease patients(ACHD) is increasing, and the management of pregnancy in ACHD is still challenging. There is no established data regarding cardiac function during pregnancy in ACHD. This study was to evaluate cardiac function during pregnancy using tissue Doppler echocardiography (TDI). TDI indices have been shown to be less load dependent than conventional method, thus sought to be suitable for evaluation during pregnancy.
Method
Sixteen ACHD patients with NYHA class I/II were recruited. Three patients were with systemic RV. Age matched control were also enrolled (n=14). Three serial echocardiographies were performed at 11-17, 21-25, and 31-34 weeks of gestation. Conventional indices; EF, FS, in-flow pattern, and Tei index were measured as well as TDI indices including isovolumic acceleration (IVA), systolic wall velocity (SW), E and A velocities. Mode of delivery, gestational age and birth weight were also recorded.
Results
All the TDI indices stayed unchanged in both groups throughout pregnancy (repeated measure of ANOVA). Two out of three with systemic RV showed significant deterioration of the RV function (decrease IVA and increased E/Ea and Tei), and required medical intervention. The birth weight of the baby from systemic RV was 17±3.5%tile, where systemic LV was 51.4±39.5%tile. Those who showed significant deterioration of LV IVA and/or FS had smaller babies(28±22%tile) than who stayed unchanged (71±41%tile).
Conclusion
TDI was useful tool to evaluate cardiac function of pregnant ACHD patients. Careful management is warranted when deterioration of LV IVA, FS and E/Ea are observed.