cardiovascular system. These changes include an increase in plasma volume by 50%, an increase in resting pulse by 17%, a decrease in systemic vascular resistance by 20% and an increase in cardiac output by 50%. After delivery, the heart rate normalizes within 10 days; by 3 months postpartum, stroke volume, cardiac output, and systemic vascular resistance return to the pre- pregnancy state. 3 Among the conditions deemed high risk cardiac pregnancy states, PAH confers the highest risk to the patient and/or the fetus. PAH is a histopathological disorder characterized by an increase in blood pressure within arteries and/or capillaries of the lungs, leading to heart failure, debilitating symptoms and shortened life expectancy. PAH in pregnancy confers a combined maternal and fetal mortality rate that approaches 50%. 3 Management of PAH in pregnancy generally consists of terminating the pregnancy. On the other hand, a double- chambered RV is a rare heart defect in which the RV is separated into a high-pressure proximal and low-pressure distal chamber. This defect is considered to be congenital and typically presents in infancy or childhood but has been reported to present rarely in adults. 4 Usually, the obstruction is caused by an anomalous muscle bundle (moderator band) crossing the RV from the interventricular septum to the RV free wall. 5 The most commonly associated cardiac anomaly with this condition is a VSD and can be seen in up to 90% patients with a double-chambered RV. 6 It is important to note, an increased tricuspid regurgitant gradient, as measured by continuous-wave Doppler on echocardiogram, may be misdiagnosed as pulmonary hypertension instead of double-chambered RV, 5 as was seen in the case above. Surgery is the primary treatment option of a double-chambered RV and should be offered to patients who are symptomatic and who have an elevated pressure gradient greater than 40 mmHg. 6 Conclusion: This case highlights that a false positive diagnosis of PAH due to increased tricuspid regurgitation on echocardiogram may be the result of a prominent moderator band in the RV leading to a double-chambered RV with a significant intracavitary gradient. Patients with suspected PAH based on results of an echocardiogram require confirmation of the diagnosis with RHC, especially in a pregnant female in which termination of pregnancy is being considered. References: 1. Bowater SE, Thorne SA. Management of pregnancy in women with acquired and congenital heart disease. Postgrad Med J . 2010;86(1012):100-105. doi: 10.1136/pgmj.2008.078030 [doi]. 2. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: Executive summary: A report of the american college of cardiology/american heart association task force on practice guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). PG -5-451. Circulation . 2008;118(23):2395-451. doi: 10.1161/CIRCULATIONAHA.108.190811. Epub 2008 Nov 7. doi: 10.1161/CIRCULATIONAHA.108.190811 [doi].
3. Franklin WJ, Benton MK, Parekh DR. Cardiac disease in pregnancy. Tex Heart Inst J . 2011;38(2):151-153.
4. Loukas M, Housman B, Blaak C, Kralovic S, Tubbs RS, Anderson RH. Double-chambered right ventricle: A review. Cardiovasc Pathol . 2013;22(6):417-423. doi: 10.1016/j.carpath.2013.03.004 [doi]. 5. Double-chambered right ventricle. Circulation . 2001;103(21):e105-e106. https://www.ahajournals.org/doi/10.1161/01.CIR.103.21.e105. Accessed Sep 8, 2020. doi: 10.1161/01.CIR.103.21.e105. 6. Patibandla S, Kyaw H. Double chambered right ventricle. In: StatPearls. Treasure Island (FL): StatPearls Publishing LLC; 2020. NBK546625 [bookaccession].
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