PHYSIOLOGICAL MULTIVALVULAR REGURGITATION DURING PREGNANCY - A LONGITUDINAL DOPPLER-ECHOCARDIOGRAPHIC STUDY

Valvular function, assessed by Doppler technique, has not been extensi vely investigated during normal pregnancy. To prospectively study this feature, 18 normal pregnant women were followed during their pregnanc ies and puerperium, with serial clinical and pulsed-continuous Doppler echocardiographic examinations. In four gestational periods and the p uerperium, we analysed: (a) ventricular and atrial dimensions, as well as valve annular diameters; (b) prevalence and characteristics of tri vial valvular regurgitations. During pregnancy, slight but significant increases of the four cardiac chamber dimensions and valve annular di ameters were observed, except for the aortic ring. The prevalence of p hysiologic valvular regurgitation in early pregnancy (mitral, 0%; tric uspid, 38.9%; pulmonary, 22.2%; aortic, 0%), was similar. to a control group of 18 healthy non-pregnant women. As pregnancy evolved, there w as a progressive and significant increase of multivalvular regurgitati on, maximal at full-term (mitral, 27.8%; tricuspid, 94.4%; pulmonary, 94.4%, P < 0.05 vs. early pregnancy). Aortic regurgitation was not det ected in any stage of pregnancy. In the puerperium, mitral regurgitati on resolved, but tricuspid and pulmonary regurgitation were still sign ificantly prevalent (83.3% and 66.7%, respectively, P < 0.05 vs. early pregnancy). It is concluded that physiologic multivalvular regurgitat ion is frequent in pregnancy, mainly involving right-sided valves in l ate gestational periods, occasionally persisting in the early puerperi um. Chamber enlargement, valve annular dilatation, and increased preva lence of trivial valve regurgitation are time-related events during no rmal pregnancy, resulting from a reversible cardiac remodeling process induced by physiologic volume overload. These aspects should be consi dered for a correct interpretation of Doppler echocardiographic findin gs in pregnant women with suspected heart disease.