Meeting abstract

https://doi.org/10.15836/ccar2019.73

Pulmonary arterial hypertension diagnosed during pregnancy – echocardiography as a tool for management

Janez Toplišek orcid.org/0000-0002-3272-1641 ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Vojka Gorjup ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Miha Lučovnik ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Tatjana Stopar Pintarič orcid.org/0000-0003-2750-5386 ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Iva Blajič ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Špela Mušič ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Barbara Krunić ; University Medical Centre Maribor, Maribor, Slovenia
Katja Prokšelj orcid.org/0000-0003-1301-632X ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Špela Tadel Kocjančič ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Anja Čopi Jerman ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
Barbara Salobir ; University Medical Centre Ljubljana, Ljubljana, Slovenia and University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia

Abstract

Introduction: Despite advanced therapies for pulmonary arterial hypertension (PAH), maternal mortality in women with PAH and their offspring remains high (30-56% and 11-28%) and is especially high
during the post-partum period1,2.
Case report: 39-years-old woman was presented in 24th week of pregnancy with moderate dyspnea and
cyanosis without peripheral edema. ECG showed right ventricular strain and NT-proBNP was 1300 ng/L. Echocardiogram showed severe precapillary pulmonary hypertension with systolic pulmonary pressure
(PAP) 103 mmHg, reduced stroke volume (SVI 29 ml/m2), normal cardiac output (CI 2.6 L/min/m2) and mildly reduced systolic function of the right ventricle (FAC 30%, PMI TDI 0.8) with normal central
venous pressure (CVP) 3 mmHg. Right heart catheterization confirmed echocardiographic hemodynamic measurements (mean pulmonary
pressure 61 mmHg, pulmonary vascular resistance (PVR) 9.4 WU) and the vasoreactivity test was negative. Epoprostenol was initiated,
titrated up to 22 ng/kg/min and on 30th week planned caesarean section was performed with NO inhalations, noradrenalin and dobutamine. Fortunately, standby supportive therapy - ECMO
and high urgency lung transplantation, was not needed. The baby did well. The patient was extubated on the same day and sildenafil was added. The patient was discharged after 4 weeks. After 2 months epoprostenol was switched to treprostinil up to 26 ng/kg/min and macitentan was added. NT-proBNP stabilized at 170 ng/L. Echocardiography was performed weekly to monitor CI, CVP and right systolic function indexes. Favorable echocardiographic dynamics after
therapy were observed: mean PAP 60 mmHg to 45-50 mmHg, PVR from 10 WU to 7 WU, stroke volume normalized and CVP remained normal.
However, right ventricular systolic function improved but did not normalize (Table 1).
In conclusion, with complete echocardiographic
hemodynamic assessment and thorough clinical assessment high-risk pregnancies in patients with severe PAH can be managed. In
addition, FAC, MPI TDI, 3D ejection fraction and RV free strain better assess right ventricular systolic function than TAPSE.

Keywords

pulmonary arterial hypertension; pregnancy; echocardiography; right ventricular function

Hrčak ID:

220599

URI

https://hrcak.srce.hr/220599

Publication date:

31.5.2019.

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