Hemodynamic changes of the heart during pregnancy including increased stroke volume, heart rate, and cardiac output can result as cardiac decompensation in women with valvular heart disease. These hemodyamic changes can unmask faulty valves in women putting them at an increased risk of acute respiratory distress and heart failure.
We present two cases of previously undiagnosed valvular heart disease that was unmasked in late pregnancy and during labor. The first patient was a previously healthy 27-year-old female who presented at 38 weeks gestation with shortness of breath. She was diagnosed with pneumonia and developed pulmonary edema and acute respiratory failure. She was intubated and an emergency cesarean delivery was performed. Echocardiogram revealed severe mitral stenosis, tricuspid regurgitation, and congestive heart failure with valvular changes consistent with rheumatic heart disease. Patient was extubated on postpartum day 11 and later underwent a mitral valve replacement. Our second patient was a 29-year-old obese gravida 6 para 3 who presented at term in labor. Pregnancy was complicated by chronic hypertension. During labor, she developed acute pulmonary edema. After a spontaneous vaginal delivery, post-delivery echo showed severe mitral and tricuspid regurgitation with cardiomegaly. Patient was scheduled for valve replacement 6 months postpartum, but was non-complaint and eventually became pregnant again. She is scheduled for a mitral valve repair possible replacement 2 months postpartum.
The hemodynamic changes of late pregnancy and labor uncovered previously undiagnosed valvular disease in these two patients. Clinicians should have a heightened suspicion for valvular disease in women presenting with respiratory complaints.