Beware the pregnant woman with breathlessness

Abstract

30. McConnell R, Berhane K, Yao L, et al. Traffic, susceptibility, and childhood asthma. Environ Health Perspect 2006;114:766-

Isolated cor triatriatum sinistrum and pregnancy: case report and review of the literature

“…[29][30][31] Six of these 13 women were first diagnosed with CTS during pregnancy; 1,12,19,23,29,30 four of them presented during the early postpartum period; 2,16,18,31 one was diagnosed with CTS at the age of 17 yr (presenting sign was transient atrial fibrillation), but she was asymptomatic until severe symptoms developed during her first pregnancy at the age of 41 yr; 25 one was diagnosed with a ''nonspecified cardiac defect'' at the age of 18 yr, was asymptomatic throughout life, but underwent further cardiac evaluation during an uneventful pregnancy; 28 and one was diagnosed in childhood with a ''hole in the heart'' but had no further workup until she became symptomatic during her first pregnancy. 17 Altogether, three asymptomatic women had cor triatriatum diagnosed through evaluation of a heart murmur, and 11 were asymptomatic Asymptomatic from cardiac standpoint during pregnancy, delivery, and postpartum; remained asymptomatic 2 yr after pregnancy AF = atrial fibrillation; ASD = atrial septal defect; CHF = congestive heart failure; CTS = cor triatriatum sinistrum; ECG = electrocardiogram; ECHO = echocardiography; LMWH = low-molecular-weight heparin; MRI = magnetic resonance imaging; NYHA = New York Heart Association; OM = obstructive membrane; PHTN = pulmonary hypertension; SpO 2 = oxygen saturation as measured by pulse oximetry * Lam's classification of cor triatriatum: type A (classic or isolated variant): proximal chamber receives all vein inflow, no ASD; subtype A1: ASD between proximal chamber and right atrium; subtype A2: ASD between distal chamber and right atrium; type B: pulmonary vein inflow into coronary sinus, which forms a variant of total anomalous pulmonary venous connection; type C: no connection between pulmonary veins and the proximal chamber…”

“…It is noteworthy that our patient remained asymptomatic despite pregnancyinduced changes in cardiovascular dynamics, as evidenced by the increase in the diastolic pressure gradient from 6.5 mmHg before pregnancy to 13.0 mmHg during late pregnancy, reflecting increased intravascular volume load. Our literature search identified ten parturients with cor triatriatum, 1,2,12,[16][17][18][19]23,25,28 and review of the bibliography of these articles revealed three additional cases (Table). [29][30][31] Six of these 13 women were first diagnosed with CTS during pregnancy; 1,12,19,23,29,30 four of them presented during the early postpartum period; 2,16,18,31 one was diagnosed with CTS at the age of 17 yr (presenting sign was transient atrial fibrillation), but she was asymptomatic until severe symptoms developed during her first pregnancy at the age of 41 yr; 25 one was diagnosed with a ''nonspecified cardiac defect'' at the age of 18 yr, was asymptomatic throughout life, but underwent further cardiac evaluation during an uneventful pregnancy; 28 and one was diagnosed in childhood with a ''hole in the heart'' but had no further workup until she became symptomatic during her first pregnancy.…”

“…The clinical course in our patient differed from reports that provide evidence that pregnancy may trigger the initial onset of cardiac symptoms in women with pre-pregnancy asymptomatic CTS (Table). 1,7,[17][18][19] To evaluate the experience with cor triatriatum during pregnancy, we performed a MEDLINE database search from January 1, 1946, to July 1, 2012 with the following MeSH terms: cor triatriatum, pregnancy, pregnancy complications, pregnancy outcome, pregnancy high-risk, labor, obstetric labor, labor onset, labor stage first, labor stage second, labor stage third, and delivery obstetric. The following keywords were used: cor triatriatum, triatriatum, polyatria$, triatria$, subdivided left atria/atrium, pregnan$, gravid$, labor, and delivery.…”

“…14,15 Nevertheless, because CTS represents an obstructive lesion that limits the ability of the heart to respond to increased demand, even the asymptomatic form may become symptomatic in states of increased cardiovascular demand. 1,16,17 For example, late pregnancy is associated with increased intravascular volume and heart rate, and this physiologic change can convert the clinical presentation of CTS from asymptomatic to symptomatic. 1,7,[17][18][19] We describe a woman with an asymptomatic isolated type of CTS who had an uncomplicated vaginal delivery with epidural analgesia.…”

“…1,16,17 For example, late pregnancy is associated with increased intravascular volume and heart rate, and this physiologic change can convert the clinical presentation of CTS from asymptomatic to symptomatic. 1,7,[17][18][19] We describe a woman with an asymptomatic isolated type of CTS who had an uncomplicated vaginal delivery with epidural analgesia. We also review the literature relating to pregnancy in patients with cor triatriatum.…”