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. 2019 Mar 19;9(2):2045894019835649. doi: 10.1177/2045894019835649

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© The Author(s) 2019

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Fig. 1. — (a) Transthoracic echocardiography (TTE) before pregnancy. TTE exhibits only moderate dilatation of right heart cavities with improved sPAP and a mild left-to-right shunt through the residual ASD (yellow arrow). (b) Postpartum TTE . TTE demonstrates a substantial increase of sPAP (now supra-systemic) with a right-to-left shunt (shunt inversion, yellow arrow) in comparison to pre-pregnancy. (c) TTE after escalation of specific PAH treatment with tadalafil, ambrisentan, and iloprost. TTE shows a significant decrease of sPAP (sub-systemic) and again left-to-right-shunt through residual ASD.