Mitral Valve Prolapse with Regurgitation: Implications for Pregnancy

Mitral valve prolapse with mitral regurgitation and tricuspid regurgitation?

Hello: Due to acute meningitis at the age of 21, with a heart rate of 166 beats per minute, a cardiac ultrasound was arranged, which revealed mitral valve prolapse with associated mitral regurgitation and tricuspid regurgitation.
I have experienced palpitations and chest tightness since childhood, but did not pay much attention to it until this year when I had two miscarriages and experienced severe palpitations during pregnancy.
Therefore, I arranged for another cardiac ultrasound this week.
My measurements are as follows: IVSd 0.77 cm, LVIDd 3.64 cm, LVPWd 0.77 cm, LVIDs 2.25 cm, EDV 56.04 ml, ESV 17.24 ml, SV 38.8 ml (compared to 48.18 ml nine years ago), EF 69.24% (compared to 65% nine years ago), %FS 38.12%, LV Mass (ASE) 76.83 g, Relative Wall Thickness 0.425, EPSS 0.30 cm, Ao Diameter 2.53 cm, LA Diameter 2.62 cm, AV Cusp 1.59 cm, LA/Ao 1.04, MV E Velocity 95.29 cm/s, MV Deceleration Time 135.59 ms, MV Deceleration Slope 7.03 m/s², MV A Velocity 101.81 cm/s, MV E/A Ratio 0.94, MV PHT 39.32 ms, MVA by PHT 5.59 cm², E'(SP) 18.307 cm/s, E/E'(SP) 5.205.
I would like to know if any issues can be identified from this data and whether my heart can handle the load during future pregnancies.

Winnie Wu, 30~39 year old female. Ask Date: 2016/07/14

Dr. He Dongjin reply Cardiology

Hello, there are no major issues; pregnancy discomfort may be caused by mitral valve prolapse leading to autonomic nervous system dysregulation.
Changhua Hospital is concerned about you.

Reply Date: 2016/07/14

More Info

Mitral Valve Prolapse (MVP) with regurgitation can have significant implications for pregnancy, especially in individuals with a history of heart conditions. Based on your description, it appears that you have been diagnosed with MVP along with mitral and tricuspid regurgitation, which can lead to various symptoms, including palpitations and chest discomfort. Given your medical history, including acute meningitis at a young age and two miscarriages, it is understandable that you are concerned about the potential impact of your heart condition on future pregnancies.

Understanding Mitral Valve Prolapse and Regurgitation
Mitral valve prolapse occurs when the valve between the left atrium and left ventricle does not close properly, which can lead to regurgitation, where blood leaks backward into the atrium. This condition can be benign in many cases, but when accompanied by significant regurgitation, it can lead to symptoms such as fatigue, palpitations, and in some cases, heart failure.

Your echocardiogram results indicate that your left ventricular ejection fraction (EF) is 69.24%, which is within the normal range (typically above 55% is considered normal). This suggests that your heart is still functioning well in terms of pumping blood. However, the fact that you have experienced increased heart palpitations and chest discomfort during pregnancy is concerning and warrants careful monitoring.

Implications for Pregnancy
1. Increased Cardiac Demand: Pregnancy naturally increases the workload on the heart due to increased blood volume and cardiac output. For individuals with MVP and regurgitation, this can exacerbate symptoms and lead to complications if the heart cannot handle the increased demand.

2. Monitoring and Management: It is crucial to work closely with both your obstetrician and a cardiologist during your pregnancy. Regular monitoring of your heart function and symptoms will be necessary. Your healthcare team may recommend echocardiograms at intervals to assess any changes in your heart's structure and function.

3. Potential Risks: While many women with MVP have successful pregnancies, there are risks involved, particularly if the regurgitation is significant. Complications can include heart failure, arrhythmias, and in rare cases, more severe cardiac events. Your history of miscarriages may also indicate that careful management is essential.

4. Lifestyle Modifications: Maintaining a healthy lifestyle can help manage symptoms. This includes staying active (as advised by your doctor), eating a balanced diet, and avoiding excessive caffeine and stress, which can exacerbate palpitations.

5. Medication Considerations: If you are on any medications for your heart condition, discuss with your healthcare provider whether these are safe during pregnancy. Some medications may need to be adjusted or changed to ensure the safety of both you and your baby.

Conclusion
In summary, while your echocardiogram results indicate that your heart function is currently stable, the presence of mitral valve prolapse with regurgitation does require careful consideration when planning for pregnancy. It is essential to have a multidisciplinary approach involving both obstetrics and cardiology to ensure the best outcomes for you and your future pregnancies. Regular follow-ups, symptom monitoring, and lifestyle adjustments will be key components of your care. Always feel free to voice your concerns and ask questions during your medical appointments to ensure you feel supported and informed throughout your journey.

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