Long-term follow-up of pregnant women after percutaneous mitral valvuloplasty

Abstract

The aim of this study was to evaluate long-term clinical follow-up and echocardiographic data on pregnant patients with mitral stenosis who underwent percutaneous mitral valvuloplasty (PMV) in our center and the development of their infants. PMV has proven to be an effective alternative to treat pregnant patients with mitral stenosis. However, long-term outcome of these patients, as well as the potential harmful effects caused by radiation on their infants, still awaits to be determined. From January 1988 to February 1999, 30 pregnant women (mean gestational duration, 24.95 +/- 5.59 weeks) underwent PMV. Twenty-three (77%) were subsequently followed by a medical interview during 5.33 +/- 3.12 years. Clinical variables such as NYHA functional class (FC), the need of a repeat PMV or surgical procedure, the presence of embolic events, and mortality rate were evaluated during follow-up. Mitral valve area, mean transmitral gradient, and the presence of mitral regurgitation were also assessed by Doppler echocardiography. Clinical data on the development of the infants were obtained from the assistant pediatricians. All patients were in NYHA FC III or IV before the procedure. During follow-up, 91% of them were in FC I and II. Two patients (9%) who had remained in FC III underwent a repeat successful PMV; no further surgery was required. There were no embolic events or death related to the procedure. Echocardiography showed an initial increase in mitral valve area from 1.14 +/- 0.22 cm(2) to 2.01 +/- 0.21 cm+/- (P < 0.0001). During long-term follow-up, it decreased to a mean of 1.75 +/- 0.24 cm(2) (P < 0. 0001). Initial transmitral valve gradient decreased from 17.73 +/- 4. 56 mm Hg to 5.91 +/- 1.80 mm Hg (P = 0.0001) and 8.95 +/- 3.58 (P = 0.002) during long-term follow-up. Twenty one children (96%), aged 4. 91 +/- 2.8 years, showed normal growth and development, and no clinical abnormalities were observed. These favorable long-term results suggests PVM to be the procedure of choice to treat pregnant women with mitral stenosis who remain in FC III or IV despite adequate medical therapy. No harmful effects due to the use of radiation were observed in the children.

Study of Effectiveness and Safety of Percutaneous Balloon Mitral Valvulotomy for Treatment of Pregnant Patients with Severe Mitral Stenosis

“…Our data are comparable to other reports of BMV in pregnancy [3][4][5][6][7][8][9][10][11][12][13][14]. Nercolini et al, obtained a success rate of 95%, which was defined by increase in final mitral valve area >1.5 cm 2 [4].…”

“…However, the loss in mitral valve area did not translate into symptomatic deterioration, because NYHA class remained almost the same at follow-up. In similar context, Mangione et al followed 30 patients for a period of 5.33±3.12 years and found that mitral valve area decreased significantly from 2.01±0.21 to 1.75±0.24 cm 2 [6]. They also noted an absence of symptomatic deterioration.…”

The long-term outcome of balloon valvuloplasty for mitral stenosis

“…In this case, PMC is the procedure of choice. The safety of PMC performed during pregnancy has been shown for both mother and fetus, allowing safe delivery in most cases [13][14][15]. Improvement of maternal functional status continues at mid-term, and clinical outcome for the child is good [16].…”

Percutaneous interventions in stenotic valvular heart disease complicating pregnancy

“…Since foetal abnormalities are more likely to occur with radiation exposure before 20 weeks of gestation [17,18], PTMC is recommended routinely after 20 weeks of gestation. A recent study has shown that over a follow up of more than 5 years, all children born to women who had undergone PTMC during pregnancy showed normal growth and development without any clinical abnormalities [19]. Risks to the foetus associated with exposure to radiation may be avoided by using transoesophageal echocardiography to guide the procedure instead of fluoroscopy.…”