Cardiovascular imaging in pregnancy

Cardiovascular imaging represents a fundamental part in the management of pregnant women with known or suspected cardiovascular disease. However, the available imaging modalities may carry different risks to the mother and fetus. Echocardiography is the safest imaging modality in pregnancy. It is the method of choice for evaluation of valvular and congenital heart disease, ventricular function, aortic disease, and assessment of hemodynamic parameters. Magnetic resonance is relatively safe and is invaluable for the evaluation of complex congenital heart disease, aortic disease, cardiomyopathies and myocarditis. Gadolinium can be harmful to the fetus and should be limited in pregnancy. Radiation exposure can also be deleterious to the fetus. The risk depends on the radiation dose and the gestational age at the time of exposure. Although common cardiovascular procedures that use ionizing radiation usually do not exceed radiation dose associated with significant fetal adverse effects, they should, nevertheless, be avoided whenever possible. If indicated, they should be performed preferably after the 12th week of gestation. In pregnancy, computed tomography is utilized in the diagnosis of pulmonary embolism, while coronary angiography is indicated in acute coronary syndrome. When deciding on imaging modality in pregnancy, both maternal and fetal benefits and risks must be taken into consideration.