Left ventricular trabeculations and noncompaction in pregnancy

Background: Left ventricular noncompaction (LVNC) is associated with a wide spectrum of presentations. One prospective study reported de novo development of left ventricular trabeculations (LVT) during pregnancy in healthy women without symptoms or left ventricular (LV) dysfunction. The long-term prognosis of LVNC and LVT are not known. Aims of the review: Our primary aim is a comprehensive review of the literature on the impact of LVNC and LVT on the outcome of pregnancy. Methods: We searched the English literature using PUBMED for pregnancy and LVNC, Left ventricular hypertrabeculation/noncompaction (LVHT) and peripartum cardiomyopathy (PPCM) with LVNC. We reviewed the publications on genetics and LVNC identifying details of pregnancies in women with LVNC. Results: Pregnancy in general appears to be well tolerated in women with LVNC or LVHT. Complications however may be severe and require device-based therapies, and heart transplantation. The mechanism or the long-term prognosis of the new LVT during pregnancy is not known. LVNC associated with PPCM seem to have worse prognosis. Conclusions: Pregnancy is not contraindicated in the majority of women with LVNC. Prognosis depends on the individual phenotype and LV function. Noninvasive evaluation should be early in pregnant women with symptoms. Multidisciplinary team to manage cardiac and obstetric complications in high-risk patients is recommended for optimal care of mother and fetus during pregnancy, labor and delivery and in early post-partum period. Future studies needed to understand the mechanisms and clinical relevance of the morphological changes occurring during pregnancy and postpartum in women with LVNC.