Percutaneous balloon mitral valvuloplasty in eight pregnant women with severe mitral stenosis

Abstract

Normal gestation is associated with a hyperdynamic adaptive state. The circulatory changes represent an additional burden on the cardiovascular system of women with rheumatic mitral stenosis (MS). Life-threatening complications can occur in pregnant women with severe MS. We successfully performed percutaneous balloon mitral valvotomy (PMV) in eight pregnant patients (mean age 28 +/- 6.9 years, range 21-38 years). Pregnancy mean age was 24.6 +/- 6.5 weeks. Five patients were in NYHA functional class III and three patients were in class IV. Emergency PMV seemed to be life saving to both mother and foetus in one case. All patients but one had pliable valves. PMV was achieved using the double balloon transseptal technique. To protect the foetus from radiation, the patient's pelvic-abdominal area was shielded and left ventriculography was not performed. The total mean time of PMV was 72 +/- 19 min and that of fluoroscopy was 16.6 +/- 7.8 min. Gorlin's mitral valve area increased from 0.83 +/- 0.15 to 2.4 +/- 0.34 cm2 and the cardiac index from 3.1 +/- 0.77 to 4.2 +/- 0.79 l.min-1.m-2. Left atrium pressure decreased from 29 +/- 10 to 14 +/- 5 mmHg and mitral valve gradient from 21 +/- 7 to 6 +/- 3 mmHg. There were no complications or residual MS. At a mean follow-up of 13.2 +/- 9.4 months, all patients were in NYHA class I and had a normal course of pregnancy. The eight women delivered healthy full-term babies. At 1-25 months post-partum follow-up, the eight infants had shown normal growth and development.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…The reported results with mitral balloon valvotomy have been excellent, with few maternal or fetal complications, although caution is advised in interpreting outcomes from individual centers reporting relatively few patients. [775][776][777][778][779][780][781][782][783][784] Percutaneous mitral balloon valvotomy should only be performed in experienced centers and only after aggressive medical measures have been exhausted. In developing countries, there is a long history of successful surgical closed commissurotomy for pregnant women.…”

Percutaneous balloon mitral valvuloplasty: Are chinese and western experiences comparable?

“…Because of the potential teratogenic risk from irradiation, PBMV should be carried out after 20 weeks gestation [ 171 with total abdominal and pelvic shielding. The Inoue balloon catheter technique is the procedure of choice, because it takes less time to perform [17,18,21,22,[27][28][29]31,33,35] and thus subjects the fetus to less X-ray exposure than the double-balloon technique [54].…”

Percutaneous balloon mitral commissurotomy during pregnancy.

“…Results-Commissurotomy was successfully achieved in all cases. The total mean (SD) duration of the procedure was 72 (18) minutes and that of fluoroscopy 16 (7) minutes. Left atrial pressure decreased from 28 (10) to 14 (7) mm Hg, mitral pressure gradient fell from 22 (8) to 5 (3) mm Hg.…”