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Correlation between Estimated Right Ventricular Systolic Pressure and Tricuspid Annular Plane Systolic Excursion to Perinatal Outcome in Pregnancy with Acyanotic Congenital Heart Disease

Author : A. Pudjiastuti, A.A. Asrial, A. Sariningrum, L. Raharjoyo, Y.A.B.M. Aruman, M.A. Nugroho, Y. Herry
Upload Date : 19-04-2018

Background: Haemodynamic consequences of pregnancy in unrepaired left to right shunt or esienmengerly acyanotic Congenital Heart Disease (CHD) maternity lead to higher risk of maternal and perinatal morbidity and mortality. Small for gestasional age (SGA) as reflection of intrauterine growth retardation (IUGR) due to chronic maternal disease may be correlated with severity of pulmonary hypertension represent by estimated right ventricular systolic pressure(RVSP) and other echocardiography parameter such as ejection fraction (EF) and tricuspid annular plane systolic excursion (TAPSE). Literatures hadn’t specifically describe the pregnancy outcome in left to right or vice versa acyanotic CHD pregnant women. 

Method: We analyzed medical record and echocardiography registry of 20 patients hospitalized with unrepaired acyanotic CHD with and without eisenmenger syndrome underwent delivery at RSUP Dr.Kariadi Semarang during August 2015 to December 2017. We exclude patients with pulmonary stenotic lession.

 

Result: Eisenmenger syndrome were identified in 10(50%) patients while 10(50%) patients were without eisenmenger, in various spectrum of acyanotic CHD. Patients with eisenmenger were older (28.18+5.52 vs 25.10+4.43 years old,p=0.499), had less gravid history (20%vs40%,p=0.085) and less miscarriage history (5% vs 15%,p=0.291). More patients in Eisenmenger group had severe pulmonary hypertension (50% vs 15%,p=0.002) and higher RVSP (106.50+20.23 vs 43+27.98 mmHg, p<0.001). Maternal in-hospital death (20% vs 0%,p=0.043) and acute respiratory failure (20% vs 0%,p=0.043) were significantly higher in eisenmenger group. While pre-eclampsia were significantly higher in non-eisenmenger group (20%vs0%,p=0.043). No statistically significant difference in prematurity, maternal ischaemic stroke, Intrauterine Fetal Death (IUFD) and IUGR in both groups. There were significantly negative correlation between RVSP to birth weight for gestasional age (r=0.587,p=0.006) and positive correlation between TAPSE (r=0.591,p<0.01) to birth weight for gestasional age among all patients. No correlation were found between EF and birth weight for gestasional age (r=0.155,p=0.513). 

Conclusion: Pregnancy with unrepaired eisenmenger CHD were at higher risk of maternal in-hospital death and acute respiratory failure in comparison with non-eisenmenger ones. Lower Birth weight for gestasional age popularly known as SGA were negatively correlate with estimated RVSP and positively correlated with TAPSE.

KEYWORDS : pregnancy, unrepaired congenital heart disease, eisenmenger, maternal outcome, perinatal outcome

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