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

Figures

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  Figure 1. The first ECG carried out during early pregnancy There is a high potential in the left ventricle, indicating left ventricular overload. There is no abnormal Q wave, QRS prolongation, or arrhythmia.

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  Figure 2. Echocardiography early in the first pregnancy The left ventricular outflow tract pressure gradient was as high as 80 mmHg.

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  Figure 3. Echocardiography at 24 weeks of the first pregnancy The left ventricular outflow tract pressure gradient worsened to 114 mmHg.

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  Figure 4. ECG after the first delivery Compared to early pregnancy, although no arrhythmia was observed, an increase in left ventricular load, an increase in T waves, and an extension of QRS was observed.

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  Figure 5. Echocardiography during the course of the first pregnancy The thickness of the left ventricular wall had reached almost 30 mm.

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  Figure 6. ECG during the first trimester of the second pregnancy The left ventricular load increased, the T wave increased, and the QRS remained unchanged. The ICD was activated by ventricular fibrillation occurring immediately with light movement.

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  Figure 7. Echocardiography during the second pregnancy The left ventricular outflow tract pressure gradient was as high as 58 mmHg.

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  Figure 8. Echocardiography before the third pregnancy The left ventricular outflow tract pressure gradient had improved to 6-13 mmHg.

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  Figure 9. Echocardiography during the third pregnancy The maximum thickness of the left ventricular wall was 21 mm.

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  Figure 10. ECG during the first trimester of the third pregnancy Although an increase in T-wave was observed, there were no findings of left ventricular load, no arrhythmia, and the ICD did not get activated.

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  Figure 11. Chest X-ray (time series display) A: Before the first pregnancy: Cardiothoracic area ratio (CTAR) of 62%, and cardiac enlargement is observed. B: After the first cesarean delivery: Poor lung field permeability and cardiac enlargement are observed (CTAR 67%). C: Before the second pregnancy: After implantable cardioverter-defibrillator (ICD) implantation, cardiac enlargement is not very noticeable (CTAR 50%). D: Before the third pregnancy. E: After the third delivery: It is almost the same as before the pregnancy.