Long-Term Outcome of Patients Undergoing Balloon Mitral Valvotomy in Pregnancy

Harikrishnan, Sivadasanpillai; Srinivasan, Anand; Sivasubramoniam, Sivasankaran; Mahadevan, Krishnamoorthy Kavassery; Kumar, Ajith; Titus, Thomas; Tharakan, Jaganmohan

doi:10.1016/j.amjcard.2005.02.025

Cited by 50 publications

(24 citation statements)

References 12 publications

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“…Percutaneous commissurotomy is the safest and most effective way of treatment both for the pregnant women and for the fetus, but because of the negative influence of X-ray radiation it should be performed after the end of organogenesis (after the 12 th week of gestational age). Specialist centres report nearly 100% safety for the pregnant woman and fetus [10][11][12][13][14][15] The results of our study confirm that PMC is a safe and effective method of treatment in patients with postrheumatic mitral valve stenosis. A successful procedure was performed in all patients with a good direct result achieved in 86.5% of them.…”

Section: Discussionsupporting

confidence: 74%

“…Previous studies showed that PMC is a method of choice in the treatment of pregnant women with haemodynamically significant mitral valve stenosis [11][12][13][14][15]. However, until now there are only a few reports on the long-term results of PMC in pregnant women and on the influence of X-ray radiation on the fetus and child development after birth [16].…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous mitral commissurotomy in pregnant women – long-term observations

Dąbrowski¹,

Chmielak²,

Dąbrowski³

et al. 2011

pwki

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A b s t r a c tBackground: Percutaneous mitral commissurotomy (PMC) can be safely performed during pregnancy. However, there is still little known about follow-up results after PMC in populations of pregnant women taking into consideration childhood development.Aim: To evaluate long-term clinical follow-up and echocardiographic data on pregnant patients who underwent PMC in our centre and development of their infants.Material and methods: From January 1989 to December 1998, 15 pregnant women with mitral stenosis and severe congestive heart failure (mean gestational duration, 31.5 ±2.7 week) underwent PMC. The procedure was successful in all patients, resulting in a significant increase (0.85 ±0.3 cm 2 ) in mitral valve area from 1.01 ±0.24 cm 2 to 2.01 ±0.33 cm 2 (p < 0.001) and New York Heart Association (NYHA) improvement to class I or II (13 and 2 patients respectively).Results: There was no maternal death, no abortion, no intrauterine growth restriction, and no stillbirth. One baby (6.6%) had cerebral palsy at birth. Long term follow-up of 17 years and 9 months was completed for 12 patients. Two patients (13%) underwent re-PMC, and one (6.6%) surgical mitral valve replacement 15, 17 and 19 years after the first procedure, respectively. All babies maintained normal growth and development without any clinical abnormalities, thyroid disease or malignancy.Conclusion: PMC is a safe and effective procedure, with favourable long-term results in the population of pregnant women with rheumatic mitral stenosis and severe congestive heart failure.Key words: mitral stenosis, mitral valvuloplasty, pregnancy, childhood development S t r e s z c z e n i e Wstęp: Zabieg walwuloplastyki zastawki mitralnej (PMC) może zostać bezpiecznie przeprowadzony u kobiet w ciąży. Dotychczas opublikowano niewiele doniesień na temat odległych wyników PMC wykonywanych u kobiet w ciąży oraz wpływu promieniowania rentgenowskiego stosowanego w czasie PMC na płód i rozwój dziecka po urodzeniu.Cel: Ocena bezpośrednich i odległych wyników komisurotomii mitralnej przeprowadzonej w Instytucie Kardiologii w Warszawie w grupie pacjentek w ciąży oraz ocena wpływu procedury na płód i późniejszy rozwój dziecka.Materiał i metody: Między styczniem 1989 r. a grudniem 1998 r. PMC wykonano u 15 ciężarnych z objawami ciężkiej niewydolności serca. Zabiegi przeprowadzono średnio w 31,5 ±2,7 tygodniu ciąży. U wszystkich pacjentek uzyskano wzrost pola powierzchni zastawki z 1,01 ±0,24 cm 2 do 2,01 ±0,33 cm 2 (p < 0,001) oraz poprawę wydolności fizycznej do I lub II klasy (odpowiednio 13 i 2 pacjentki) wg NYHA. Nie obserwowano powikłań w czasie dalszego przebiegu ciąży.Wyniki: U jednego noworodka zdiagnozowano porażenie mózgowe. Dane dotyczące obserwacji odległej wynoszącej średnio 17 lat i 9 miesięcy zebrano od 12 pacjentek. U 2 chorych (13%) wykonano re-PMC, u jednej (6,6%) operację wymiany zastawki mitralnej, odpowiednio 15, 17 i 19 lat po pierwszym zabiegu. Wszystkie dzieci żyją. Poza chłopcem z porażeniem mózgowym, rozwijają się prawidłowo i są zdrowe fizyczn...

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Percutaneous mitral commissurotomy in pregnant women – long-term observations

Dąbrowski¹,

Chmielak²,

Dąbrowski³

et al. 2011

pwki

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“…Operative mortality was 4.7% (5 of 106 patients) (67). Multivariate analysis showed prior myocardial infarction and "non- 21,23, and 25 MMP had lower resistance than the CEP at low flow rates (3 l/min), after which the MMP showed steep increases in resistance, and at flow rates of Ն4 l/min the CEP had much lower rates of resistance ( Fig. 9) (68).…”

Section: Prosthetic Heart Valvesmentioning

confidence: 95%

The Year in Valvular Heart Disease

Rahimtoola

2006

Journal of the American College of Cardiology

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“…This hemodynamic aberration leads to a relatively fi xed CO. Although initially the left atrium may overcome this obstruction, with progression of the disease left atrial volume and pressure increase and lead to a progressive increase in pulmonary capillary wedge pressure and pulmonary venous pressure; pulmonary hypertension and right ventricular hypertrophy and failure may then occur [1,6,[21][22][23][24][25][26][27][28]. Fetal mortality rates increase with deteriorating maternal condition and reach 25% in pregnant women with severe mitral stenosis.…”

Section: Mitral Stenosismentioning

confidence: 99%

Anesthesia for pregnant women with valvular heart disease: the state-of-the-art

Kuczkowski

Zundert²

2007

J Anesth

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Pregnancy results in dramatic changes in the cardiovascular system. Maternal heart disease complicates 0.2%-3% of pregnancies. Valvular heart disease in women of reproductive age is most commonly due to rheumatic heart disease, endocarditis, or congenital abnormalities. In general, regurgitant lesions are well tolerated during pregnancy because the increased plasma volume and lowered systemic vascular resistance result in increased cardiac output. In contrast, stenotic valvular disease is poorly tolerated with advancing pregnancy, owing to the inability to increase cardiac output in relation to the increased plasma volume preload. The choice of anesthesia depends on the lesion and its severity. Usually, regional anesthesia provides the least amount of alteration in hemodynamics, although general anesthesia for cesarean section can be equally safe when the abrupt changes associated with laryngoscopy, intubation, and extubation are blunted by the appropriate choice of pharmacological agents and anesthetic techniques.

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Long-Term Outcome of Patients Undergoing Balloon Mitral Valvotomy in Pregnancy

Cited by 50 publications

References 12 publications

Percutaneous mitral commissurotomy in pregnant women – long-term observations

Percutaneous mitral commissurotomy in pregnant women – long-term observations

The Year in Valvular Heart Disease

Anesthesia for pregnant women with valvular heart disease: the state-of-the-art

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