Pulmonary artery dilatation during normal pregnancy

Background: During pregnancy the cardiovascular system undergoes complex alterations; however, there have been few studies concerning pulmonary artery behaviour during gestation. Aim: The aim of this study was to evaluate changes in the pulmonary artery diameter (PAD) during gestation, with respect to left ventricular (LV) load and remodelling, as well as to systemic vascular resistance (SVR). Methods: It was a prospective cohort study, which included 69 consecutive healthy outpatient women with a singleton pregnancy. Echocardiography and ultrasonography of the uterine arteries were performed at two visits (V1 and V2) during pregnancy, and only echocardiography at one visit postpartum. Results: Pulmonary artery diameter increased in all women, from 20.0 mm at V1 to 22.7 mm at V2 (p < 0.001), and it returned to the reference range postpartum (19.5 mm; p < 0.001 vs. V2). Echocardiography did not reveal any other abnormalities, including the signs of intracardiac shunt or right ventricular pressure overload. During V2, PAD positively correlated with the following echocardiographic parameters: LV end-diastolic diameter (r = 0.386; p = 0.002), LV end-systolic diameter (r = 0.345 p = 0.006), LV end-diastolic volume (r = 0.308; p = 0.016), LV mass (r = 0.459; p < 0.001), left atrial area (r = 0.334; p = 0.009), LV cardiac output (r = 0.338; p = 0.011), and aortic diameter (r = 0.369; p = 0.003). Furthermore, there was a negative linear correlation between PAD and SVR (r = –0.307; p = 0.025) and pulsatility index (r = –0.318; p = 0.012). Conclusions: Our study shows pulmonary artery dilatation in healthy pregnant women without any other abnormal echocardiographic findings. These changes in PAD are associated with volume overload and low vascular resistance, and during postpartum they usually subside

Right ventricle to pulmonary artery coupling as a predictor of perioperative outcome in patients with secondary mitral valve insufficiency

Background: The aim of the study was to assess some parameters of right ventricle (RV) function aspredictors of short-term mortality in patients with severe secondary mitral regurgitation (SMR) aftermitral valve surgery.Methods: We conducted a retrospective analysis of 112 consecutive patients with severe SMR whohad undergone mitral valve repair or replacement with or without concomitant coronary artery bypasssurgery. We assessed RV to pulmonary artery coupling by calculating the ratio of tricuspid annularplane systolic excursion (TAPSE) to non-invasively estimated RV systolic pressure (RVSP). The studyendpoint was 30 days post-procedural mortality.Results: Overall, the 30-day mortality was 6%. TAPSE/RVSP ratio < 0.42 mm/mmHg was a significantpredictor of mortality and remained so after adjusting for age and sex. The Kaplan-Meier survivalanalysis showed that patients with RVSP > 55 mmHg and those with TAPSE/RVSP ratio < 0.42 mm/mmHg had a lower survival probability.Conclusions: TAPSE/RVSP < 0.42 mm/mmHg is a strong predictor of short-term mortality in patientswith SMR when considered for valve surgery