Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure

Pillai, Ajith Ananthakrishna; Ramasamy, Chandramohan; Gousy, Saranya; Kottyath, Harichandrakumar

doi:10.1111/joic.12507

Cited by 15 publications

(18 citation statements)

References 17 publications

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“… 10 , 11 , 12 , 13 , 14 However, mortality of 11.4% after BMV has been shown in a high risk cohort of patients who presented with decompensated heart failure during pregnancy. 15 The author in this study found a high Wilkin's score, hypoxia and pulmonary hypertension to be predictors of mortality in these patients.…”

Section: Discussionmentioning

confidence: 62%

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Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy

Chatterjee

Khanna

Sahu

et al. 2020

Indian Heart Journal

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Objectives To study the immediate maternal and fetal outcomes and long term maternal outcomes in pregnant women undergoing balloon mitral valvotomy. Methods We retrospectively analyzed balloon mitral valvotomy during pregnancy performed between January 2008 and July 2018. Results BMV was carried out in 97 pregnant women with mean age of 26.1 ± 4.5 years, at mean gestational age of 23.1 ± 4.6 weeks. The procedure was successful in 95 patients (97.9%). There was one maternal death post procedure due to intra-uterine death and disseminated intravascular coagulation. Adverse immediate fetal outcome was seen in 2 cases with one intra-uterine fetal demise and one preterm labour. Mitral valve area increased from mean of 0.82 ± 0.12 cm to 1.66 ± 0.14 cm (p < 0.001). Mean trans-mitral diastolic gradient decreased from 19.7 ± 5.6 mm Hg to 7.5 ± 2 mm Hg. Right ventricular systolic pressure decreased significantly from mean of 56.7 ± 16.2 mm Hg to mean of 35.6 ± 11 mm Hg. Survival analysis showed cumulative event free survival of 89% at 5 years and 65% at 10 years, considering a composite endpoint of clinical restenosis, repeat BMV or MVR or cardiovascular death. Conclusions Balloon mitral valvotomy is a safe and effective treatment for severe mitral stenosis during pregnancy. Long term maternal outcomes after BMV done during pregnancy are good and comparable to that of BMV done in non-pregnant patients.

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Section: Discussionmentioning

confidence: 62%

“…and between 3.3% and 7% patients in previously published studies of non-pregnant population. 15 , 16 , 17 , 18…”

Section: Discussionmentioning

confidence: 99%

Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy

Chatterjee

Khanna

Sahu

et al. 2020

Indian Heart Journal

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“…Three additional studies were identified through reference search of the included studies. Altogether, 21 articles were finally included in the review, after excluding one article from the same author with an overlap in the time period of inclusion of cases 18‐38 . Characteristics of the studies are shown in Table .…”

Section: Resultsmentioning

confidence: 99%

“…The pooled estimate of PBMV complicated with MR was 12.7% (95% CI 7.3%‐19.1%) (Figure 1A). Following PBMV, 16 cases underwent mitral valve replacement for either acute MR (n = 8) or a failed procedure (n = 8) 19,21,27,38 . Various access site complications, including minor groin hematoma, acute arterial occlusion at the site, femoral artery thrombosis, arteriovenous fistula at the site of puncture and common femoral artery pseudo‐aneurysm were also reported.…”

Section: Resultsmentioning

confidence: 99%

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Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta‐analysis

Sreerama

Surana

Moolchandani

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The objective of this study was to systematically review the maternal and fetal outcomes in pregnant women who underwent percutaneous balloon mitral valvuloplasty (PBMV) during pregnancy. Material and methods A search was conducted on MEDLINE and Embase databases to identify studies published between 2000 and 2018 that reported on maternal and fetal outcomes following PBMV performed in pregnancy. Randomized controlled trials, cohort studies, case‐control studies, cross‐sectional studies and case series with four or more pregnancies in which PBMV was performed during pregnancy were included. Reference lists from relevant articles were also hand‐searched for relevant citations. A successful procedure was defined as one where there was a reported improvement in the valve area or reduction in the mitral valve gradient. A random effects model was used to derive pooled estimates of various outcomes and the final estimates were reported as percentages with a 95% confidence interval (95% CI). Results Twenty‐one observational studies reporting 745 pregnancies were included in the review, all of them having reported outcomes without a comparison group. Most of the studies fell into the low‐risk category as determined using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. Most of the studies (86%) were reported from low‐ to middle‐income countries and PBMV was mostly performed during the second trimester of pregnancy. Forty‐three procedures (5.7%) were unsuccessful, nearly half (n = 19) of them reported among women with the severe subvalve disease (Wilkins subvalve score 3 or more). There were 11 maternal deaths among those with suboptimal valve anatomy (severe subvalve disease or Wilkin score >8). Mitral regurgitation was the most common cardiac complication (12.7%; 95% CI 7.3%‐19.1%), followed by restenosis (2.4%; 95% CI 0.02%‐7.2%). Pooled incidence of cesarean section was 12.1% (95% CI 3.6%‐23.8%), preterm delivery 3.9% (95% CI 0.6%‐9.0%), stillbirth 0.9% (95%CI 0.2%‐2.2%) and low birthweight 5.4% (95% CI 0.2%‐14.7%). Conclusions PBMV may be an effective and safe procedure for optimizing outcomes in pregnant women with mitral stenosis in the absence of severe subvalve disease.

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Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Chioncel

Adamo

Nikolaou³

et al. 2023

European J of Heart Fail

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Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patient's underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence‐based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear‐cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF.

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Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure

Cited by 15 publications

References 17 publications

Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy

Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy

Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta‐analysis

Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

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