Impact of Pregnancy on Ventricular Strain in Women with Repaired Tetralogy of Fallot
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ORIGINAL ARTICLE
Impact of Pregnancy on Ventricular Strain in Women with Repaired Tetralogy of Fallot Valeria E. Duarte1,2,3 · Julia A. Graf1 · Kimberlee Gauvreau1 · Sarah Rae Easter4 · Sheila C. Drakeley1 · Matthew R. Carazo1,2 · Katherine E. Economy4 · Anne Marie Valente1,2 · David M. Harrild1 Received: 19 May 2020 / Accepted: 30 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Increasing numbers of women with repaired tetralogy of Fallot (rTOF) are reaching reproductive age and seek counseling regarding their cardiovascular risks related to pregnancy. Therefore, the aim of this study was to characterize changes in left ventricular (LV) strain in women with rTOF during pregnancy and in the postpartum period. Seventeen pregnancies in women with rTOF were included (mean age at repair = 3.2 years ± 5.5 years; mean age at delivery = 32.7 ± 4 years). Echocardiograms from three time periods were analyzed; baseline (prior to conception or in the first trimester), third trimester, and 4–6 weeks postpartum. Sixty-five percent of the patients had at least mild pulmonary regurgitation. Eight patients (47%) had undergone at least one pulmonary valve replacement. There were no changes in LV ejection fraction (EF) or circumferential strain across the three time periods. Significant differences were present in longitudinal strain within the three time points (p = 0.01). Postpartum strain decreased in magnitude compared to the third trimester value (− 17.7 ± 4.1 vs. − 21 ± 5, p-value = 0.003) but was not different when compared to baseline strain (− 17.7 ± 4.1 vs. − 19.4 ± 3.4; p-value = 0.15). In conclusion, in women with rTOF, changes in longitudinal strain were observed during pregnancy with a return to baseline after delivery; EF did not change. These findings provide evidence that pregnancy does not adversely impact LV mechanics in the short term in this potentially vulnerable patient population. Keywords Pregnancy · Tetralogy of fallot · Echocardiography · Myocardial strain
Introduction
Anne Marie Valente and David M. Harrild have contributed equally to this manuscript. * Anne Marie Valente [email protected] 1
Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
2
Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
3
Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
4
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Left ventricular (LV) dysfunction has been reported in 20% of adults with repaired tetralogy of Fallot (rTOF) and is associated with a risk of early mortality [1]. While the etiology of this dysfunction is not completely understood, it is known that LV dysfunction is associated with increased risk of sudden cardiac death in patients with rTOF [2–4]. Although
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