Evaluation of Cardiac Function in a Patient With Hypertrophic Cardiomyopathy Before and During Pregnancy to Predict Its Outcome: A Case Report

TL;DR

This case report follows a woman with hypertrophic cardiomyopathy through multiple pregnancies to understand how the condition affects pregnancy outcomes and how to better predict risks.

Contribution

The study provides insights into the progression of HCM during pregnancy and evaluates the usefulness of specific risk scores for predicting outcomes.

Findings

The patient's HCM worsened during the second pregnancy, leading to ICU treatment and termination due to arrhythmias.

After surgery, the third pregnancy progressed without complications, showing the importance of disease management.

Risk scores like ZAHARA and CARPREG II were found to be useful for assessing HCM during pregnancy.

Abstract

The risk of maternal and neonatal mortality in pregnant women with hypertrophic cardiomyopathy (HCM) is considered low, and prognostic methods have not yet been established. In this study, we evaluated several pregnancies in the same patient. In each case, we were able to assess the severity of the mother's cardiac disease and estimate the prognosis. By reviewing the severity of the disease over time and its actual course, we verified the kind of assessment that is important for predicting prognosis. We present the case of a patient who was diagnosed with HCM at 18 years of age and had her first spontaneous pregnancy at 25 years of age. The baby was born at 38 weeks and was healthy, but the mother's HCM worsened after the second trimester of pregnancy, and treatment in the intensive care unit was needed after delivery. After an implantable cardioverter-defibrillator (ICD) implantation, a second pregnancy was established. However, due to repeated arrhythmias requiring ICD activation, a termination of pregnancy was performed due to the risk of worsening maternal heart failure. After radical septal myectomy, a third pregnancy was achieved. In this case, the left ventricular outflow tract stenosis disappeared, the left ventricular outflow tract pressure gradient decreased, and the pregnancy progressed well with no maternal complications. The New York Heart Association (NYHA) and modified World Health Organization (WHO) scores before conceiving were not sufficient to predict pregnancy outcomes. Changes in the disease status during pregnancy were generally consistent with the Zwangerschap bij Aangeboren HARtAfwijkingen (ZAHARA) or pregnancy and congenital heart disease score, Cardiac Disease in Pregnancy Study II (CARPREG II) score, and modified WHO classification ratings, suggesting that they are suitable for assessing risk during pregnancy, and before and after delivery in patients with HCM.

Figures