What echocardiogram finding indicates the highest potential risk for pregnancy in a woman with a ventricular septal defect?

In the context of a woman with a ventricular septal defect (VSD), the presence of pulmonary hypertension on an echocardiogram indicates the highest potential risk for pregnancy. This risk is primarily due to the fact that pulmonary hypertension can lead to increased right ventricular afterload, which may compromise cardiac function, especially during the increased hemodynamic demands of pregnancy.

During pregnancy, there is an increase in blood volume and cardiac output, which can exacerbate any underlying cardiac conditions. In patients with VSD, if pulmonary hypertension is present, the right ventricle may be unable to cope with the additional demands. This can further elevate pressures within the pulmonary circulation, potentially leading to right heart failure and severe complications.

Among the other options, while associated aortic regurgitation, a bicuspid aortic valve, and a high systolic pressure gradient may pose risks, pulmonary hypertension is the most critical factor that can significantly affect the overall hemodynamics and the ability of the heart to manage the physiological changes associated with pregnancy. Therefore, a woman with a VSD who also shows signs of pulmonary hypertension would be at the greatest risk during pregnancy, making this echocardiographic finding particularly significant.