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Table 4 Changes on echocardiography in pregnancy that should raise an alert and prompt clinical review [27, 40]

From: Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society

Condition

Level of evidence and strength of recommendation

General recommendations

  

  General

• Large one-off, or stepped changes in parameters, even if they remain in the normal range

IC

• Measurements that fall outside normal values

IC

  Arrhythmia

• Any abnormal rhythm, e.g. loss of sinus rhythm, frequent premature ventricular complexes

IC

  Aortopathy

• Any progression of aortic dilatation

IC

Valvular heart disease

 

  Aortic stenosis

• Any decrease in LVEF, especially if accompanied by fall in transvalvar velocity

IC

• Any increase in LV systolic or diastolic dimensions

IIC

• Tachycardia on echo (> 100 beats per minute)

IC

  Mitral stenosis

• Any new diagnosis of mitral stenosis

• Progression of severity

• New onset atrial fibrillation

• Left atrial spontaneous contrast or suspicion of thrombus

• Any deterioration in RV function, increase in PA pressure or increase in RV dimensions

IC

IC

IC

IC

IIC

  Pulmonary stenosis

• Deterioration in RV function

• Increasing severity of tricuspid regurgitation

IC

IIC

  Mitral regurgitation

• Deterioration in LV function

• Increase in LV systolic or diastolic dimensions

• Increase in severity of mitral regurgitation

IC

IC

IC

  Aortic regurgitation

• Deterioration in LV function

• Increase in LV systolic or diastolic dimensions

• Increase in severity of aortic regurgitation

IC

IC

IC

  Pulmonary regurgitation

• Progressive increase in RV dimensions

• Reduction in RV systolic function

• Increasing severity of tricuspid regurgitation

IIC

IC

IIC

  Tricuspid regurgitation

• Progressive increase in RV dimensions

• Reduction in RV systolic function

• Increasing severity of tricuspid regurgitation

IIC

IC

IIC

  Prosthetic valves

• Any suspicion of mechanical valve dysfunction suggesting possible valve thrombosis

• Other imaging modalities (fluoroscopy and/or TOE, rarely CTa) should be considered

IC

IIC

Cardiomyopathy

 

  PPCM

• New LV dysfunction

IC

• Serial reduction in LV function

IC

• Serial increase in LV dimensions

IC

• Evidence of abnormalities associated with poor prognosis including:

 

 • LVEF ≤ 30%

IC

 • LVEDd ≥ 6 cm

IC

• RV dilatation and dysfunction

IIC

  Dilated cardiomyopathy and previous PPCM

• Serial reduction in LV function

• Serial increase in LV dimensions

IC

IC

  Hypertrophic cardiomyopathy

• Newly detected LVOT obstruction

• Deterioration in systolic or diastolic LV function

• Increase in E/e’

• Loss of sinus rhythm

IC

IC

IIC

IIC

  Arrhythmogenic cardiomyopathy

• Deterioration in ventricular function

• Increase in degree of tricuspid regurgitation

• Frequent or complex ventricular ectopy

IC

IIC

IIC

  Pulmonary arterial hypertension

• Any deterioration in RV function

• Evidence of rising pulmonary artery pressure

• Progressive tricuspid regurgitation

IC

IC

IIC

Congenital heart disease

 

  Tetralogy of Fallot

• Deterioration in RV function

• Progressive tricuspid regurgitation

IC

IIC

  Transposition of the great arteries (dTGA)

Post arterial switch operation:

 

 • New LV dysfunction

IC

 • Progressive dilatation of neo aortic root or aortic regurgitation

IIC

 • If right-sided obstruction, worsening of RV function or progressive TR

IIC

Post Senning or Mustard repair:

 

 • Deterioration in systemic RV function

IC

 • Progression of systemic tricuspid regurgitation

IIC

Post Rastelli operation:

 

 • New LV dysfunction

IIC

  Congenitally corrected TGA

• New or deteriorating systemic RV dysfunction

• Progressive systemic tricuspid regurgitation

IC

IIC

  Fontan circulation

• New or deteriorating ventricular dysfunction

• New or deteriorating atrioventricular valve regurgitation

• Loss of sinus rhythm

IIC

IIC

IIC

  1. Deterioration in ventricular function should be considered as a deterioration compared to the previous study. Any change in valve function should be considered as a change of ≥ 1 grade of stenosis or regurgitation
  2. DCM dilated cardiomyopathy, EF ejection fraction, LV left ventricle/ventricular, LVOT left ventricular outflow tract, LVEDd left ventricular end diastolic diameter, PA pulmonary artery, PPCM peripartum cardiomyopathy, RV right ventricle/ventricular, TGA transposition of the great arteries, TOE transoesophageal echocardiography, TR tricuspid regurgitation
  3. aCT should be used if fluoroscopy and/or TOE are not diagnostic. It should not be avoided because of the radiation dose in a potentially high risk situation