Volume challenge in women with congenital heart disease during reproductive age and pregnancy outcomes.

Abstract

Background: Thanks to medical improvements in the care for patients with congenital heart disease (CHD), women with CHD reach reproductive age. Pregnancy is not without risk due to the cardiovascular changes that occur. University Hospitals Leuven use a standardised protocol, including a catheterisation and volume challenge, to assess these women before pregnancy. This protocol has never been evaluated.

Objective: The primary aim was to evaluate this volume challenge protocol. The second objective was to investigate whether hemodynamic data obtained during cardiac catheterisation were associated with maternal and/or neonatal outcome.

Methods: A single-centre, retrospective study was conducted. Primarily, changes in catheterisation measurements were evaluated. Second, correlation statistics investigated associations between catheterisation data and outcome.

Results: Twenty-five women, with nine different CHDs were eligible for inclusion and underwent a catheterisation with volume challenge. Significant changes in pre- and post-volume challenge measurements were observed in the mean averaged systemic venous pressure (ASVP) (p < 0.001), diastolic and mean pulmonary artery pressures (p < 0.001), and the pulmonary capillary wedge pressure (p < 0.001). A negative correlation was observed between the pre-test ASVP and the neonatal gestational age at delivery (p = 0.002). Another negative correlation was found between the post-test cardiac index (CI) and gestational age at delivery (p = 0.049) and birthweight (p = 0.018).

Conclusion: The results suggest that higher ASVP is associated with lower gestational age at delivery. Remarkably, higher CI was related with lower gestational age and birthweight. However, our data do not support that a systematic volume challenge in women with CHD can be considered as a reliable prediction test.