Pregnancy in Cardiac Patients: Possible Influence of Volume Overload by pregnancy on Pulmonary Circulation

Abstract

To evaluate the influence of volume overload by pregnancy on heart diseases, the relations between cardiac status before pregnancy and clinical courses during pregnancy were studied, especially from the viewpoint of pulmonary circulation. In 206 pregnant cardiac patients whose prepregnancy laboratory data were known, the deterioration (appearance or advance of heart failure) during pregnancy was prospectively related to: pulmonary congestion (p < 0.05), enlarged left atrium (p < 0.05), atrial fibrillation (p < 0.01) and right ventricular hypertrophy (p < 0.005) in mitral stenosis; cardiomegaly (p < 0.05) and atrial fibrillation (p < 0.005) in mitral regurgitation; cardiomegaly (p< 0.005) in congenital heart diseases; and to previous congestive heart failure (p < 0.005) in total cases. All of the cases with systolic pulmonary artery pressure higher than 50 mmHg deteriorated during pregnancy. Some cases with no deteriorating laboratory findings showed dyspnea suddenly at the end of pregnancy. In 1033 cardiac patients who had experienced pregnancy, deterioration during pregnancy was seen more frequently in cases with mitral valvular diseases that in those with aortic valvular diseases. No deterioration was seen in pulmonary stenosis patients. Abnormal status of pulmonary circulation may be one of the important determining factors of deterioration by pregnancy in cardiac patients. The criteria for permitting pregnancy in cardiac patients are proposed. © 1986, The Japanese Circulation Society. All rights reserved.