Immediate Results of Percutaneous Trans-Luminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis

Abstract

BackgroundValvular heart diseases and mainly rheumatic heart diseases complicate about 1% of pregnancies. During pregnancy physiological hemodynamic changes of the circulation are the main cause of mitral stenosis (MS) decompensation. Prior to introduction of percutaneous mitral balloon commissuroplasty (PTMC), surgical comissurotomy was the preferred method of treatment in patients with refractory symptoms. PTMC is an established non-surgical treatment of rheumatic mitral stenosis. The study aimed to assess the safety and efficacy of PTMC in pregnant women with severs mitral stenosis.Material and MethodThirty three consecutive patients undergoing PTMC during pregnancy enrolled in this prospective study. Mitral valve area (MVA), transmitral valve gradient (MVG), and severity of mitral regurgitation (MR) were assessed before and 24 hour after the procedure by transthoracic and transesophageal echocardiography. Mitral valve morphology was evaluated before the procedure using Wilkin’s criteria. Patient followed for one month and neonates monitored for weight and height and adverse effect of radiation.ResultMitral valve area increased from 0.83 ± 0.13 cm2 to 1.38 ± 0.29 cm2 (P = 0.007). Mean gradient of mitral valve decreased from 15.5 ± 7.4 mmHg to 2.3 ± 2.3 mmHg (P = <0.001). Pulmonary artery pressure decreased from 65.24 ± 17.9 to 50.45 ± 15.33 (P = 0.012). No maternal death, abortion, intrauterine growth restriction was observed and only one stillbirth occurred.ConclusionPTMC in pregnant women has favorable outcome and no harmful effect on children noted.

Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis

“…The mean fluoroscopy time was between 5.5 and 9 minutes in several studies, 5,[10][11][12] while in our study, it was approximately 4.5 times shorter (i.e., 97.01±38.82 sec), which is below the harmful radiation time. During catheter balloon commissurotomy, the radiation exposure to the fetus is calculated to be less than 0.2 rad with the use of abdominal and pelvic shielding.…”

“…The rate of maternal death and major cardiac events and abortion caused by complications was also very low in other studies. 5,9,16,20 In our case series, we found 4 preterm labors, 5 pregnancies with low birth weights, 3 abortions, and 1 stillbirth due to IUGR, which appears to be acceptable in comparison with other studies. Steves et al 15 reported a 13% rate of preterm labor in their study.…”

“…Steves et al 15 reported a 13% rate of preterm labor in their study. In an investigation by Abdi et al, 5 no abortion was detected and 1 stillbirth was reported. Routray and colleagues, 11 in their analysis of 40 pregnant women who underwent PTMC, found no maternal death, abortion, or IUGR.…”

“…[10][11][12][13][14] Several studies on the role of PTMC in pregnant women have reported a twofold increase in the postprocedural MVA (0.8-1 to 1.2-2.5). 5,10,12,[15][16][17][18][19][20] In the majority of these studies, the MVA was measured using the Gorlin equation. However, in recent works, including our study, the MVA was measured via the direct planimetry method using TTE.…”

“…4 The high fetal and maternal mortality rate (1.8%-33%) of surgery and the acceptable procedural success of percutaneous transluminal mitral commissurotomy (PTMC) have made the latter modality a reliable therapy for pregnant women. 5 Indubitably, PTMC during pregnancy remains a high-risk procedure. Apart from the procedural stress on the fetus and the potential hemodynamic deterioration during the intervention, radiation exposure is another major issue.…”