Maternal haemodynamical adaptation in a pregnancy with post-radiotherapy cardiopathy and dysmetabolism

Objective. To evaluate the cardiovascular adaptation in case of maternal heart-disease associated with dysmetabolism.
Materials and Methods. We present the case of a 44 -year-old woman affected by post-radiotherapy cardiopathy, characterized by double valvulopathy (moderate aortic-mi­tralic regurgitation), mild systolic and moderate diastolic dysfunction (TAPSE-16mm), and increased pulmonary pressure (PAPS-42 mmHg). The patient conceived via in vitro fertilization and was referred to our tertiary centre at 13 weeks of gestation. Baseline NYHA class was II-III. The patient presented several co-morbidities: chronic hyper­tension, impaired glucose tolerance and class II obesity. At the first trimester scan, the uterine arteries mean pulsatility (mean-UtAPI) index was above 95° percentile. Haemody­namic assessments were performed with USCOM device revealing a hypodynamic pattern (5.8 CO, 1,232 RVS, 70 SV). Introducing insulin for the dysmetabolism, along with a regimen of diuretic, betablocker, acid acetylsalicylic and low-molecular-weight-heparin, we observed significant im­provements at the following evaluation at 23 weeks. There was a significant reduction in the RVS (872), an increase of both CO (7.3) and SV (88), an improvement of diastol­ic function (TAPSE-19 mm) and a reduction of PAPS (30- mmHg) as well as normalization of the uteroplacental flow (mean-UtA PI71° percentile).
Results. Pregnancy progressed without any obstetrical or maternal complication. Delivery was expedited at 36 weeks of gestation. No complications were observed during the post-partum period. The mother was discharged on the 9th day after delivery with good haemodynamic compensation, along with her baby.
Conclusions. Metabolic homeostasis is of paramount im­portance in the cardiovascular adaptation during pregnancy, even in case of severe maternal heart disease.