Closed mitral valvotomy during pregnancy:A 20-Year Experience

Abstract

Closed mitral valvotomy for rheumatic mitral stenosis was performed on 126 pregnant women (average duration of pregnancy c. 21 weeks), 91% of whom were in NYHA functional class III or IV. Associated functional tricuspid regurgitation was present in 47 (37%) of the women, and 102 (81%) had critical mitral stenosis (digitally assessed valve area less than 1 cm2). There was no surgical mortality. Postoperatively 84% of the women were in NYHA class I. Clinical evidence of pulmonary artery hypertension and tricuspid regurgitation regressed postoperatively in most patients. Full-term normal delivery was achieved in 82% of the pregnancies, with total fetal mortality 6%. There were no congenital abnormalities and the infants' progress was normal. At 5-year follow-up 86% of the women were in NYHA class I or II and at 10 years the figure was 60%. The restenosis rate was 2%/year and the late mortality 3.3%. Closed mitral valvotomy during pregnancy thus was safe and reliable, giving significant functional and clinical improvement without adversely affecting the fetus.

Emergency tricuspid valve replacement during pregnancy

“…It follows that in the setting of deteriorating maternal functional class and emergency surgery, both maternal and fetal mortality increase dramatically. It has been suggested that fetal mortality as high as 50% exists for functional class III and IV patients undergoing CPB [6,7]. In a recent review, the only two maternal deaths following surgery in a period from 1992-2002, involving 22 patients, were gravid patients who presented to the OR with endocarditis and class IV functional status, which is similar to our patient at the time of her operation [6].…”

Anesthetic management for emergency cesarean section in a patient with severe valvular disease and preeclampsia

“…This report, however, involved only a few patients. 11 Interestingly, our patient's hemodynamic instability completely resolved after delivery, eliminating the need for valvuloplasty. This outcome strongly supports the contention that the physiologic changes of pregnancy and preeclampsia resulted in acute hemodynamic decompensation, hence delivery could be considered as a therapeutic intervention in this circumstance.…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…In developing countries, there is a long history of successful surgical closed commissurotomy for pregnant women. 785 …”