Commissurotomy and pregnancy: A study of 245 cases

Matorras, Roberto; Reque, J.A.; Mínguez, J.; Usandizaga, J. A.; Pedroviejo, G.; Perera, S. Ajith; Larrea, J.L.; Núñez, Lisardo

doi:10.3109/00016348609157036

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Despite improvements in medical treatment, mitral stenosis in pregnancy remains a dangerous condition for the woman and her infant. In addition, surgical interventions during pregnancy carry considerable risks 4 . Percutaneous balloon mitral valvulotomy lessens these risks and is available in centres with the necessary experience.…”

Section: Discussionmentioning

confidence: 99%

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Mitral stenosis in pregnancy: a four‐year experience at King Edward VIII Hospital, Durban, South Africa

Desai¹,

Adanlawo²,

Naidoo

et al. 2000

BJOG

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Objective To evaluate prospectively mitral stenosis in pregnancy with emphasis on women with persisSetting King Edward VIII Hospital, a tertiary referral obstetric unit.Participants One hundred and twenty-eight consecutive women with mitral stenosis. DemographicsThe mean age was 27 years and 38 women (30%) were primigravidae. Seventy-eight (61%) women had their first cardiac evaluation in the third trimester. Fifty-four women (42%) of these women had mitral stenosis diagnosed for the first time in the index pregnancy. Twenty-nine (23%) had a previous mitral valvulotomy. Nineteen women (15%) developed hypertension during pregnancy, 10 of whom had pre-eclampsia. Sixty-three women (49%) had a mitral valve area of I 1.2 cm2 with 11 having critical mitral stenosis (mitral valve area I 0.8 cm2). Atrial fibrillation was present in 12 women. Most women (87%) required medical therapy to control the heart rate.Outcome in persistent symptomatic women Intervention was considered in 37 women (29%) who remained symptomatic, 11 (9%) of whom had a calcified mitral valve. The remaining 26 women were scheduled for balloon mitral valvulotomy during pregnancy, 20 of whom had balloon mitral valvulotomy with good effect (16 antepartum; 4 postpartum). In seven women, scheduled balloon mitral valvulotomy was not performed because of advanced preterm labour (n = 3, fetal distress (n = 1) and preterm labour with fetal distress (n = 1). These seven, together with the 11 with calcific mitral stenosis, were managed conservatively with good outcome.Maternal complications Fifty-one percent had maternal complications, the majority occurring at their initial admission to hospital. Pulmonary oedema was the most frequent. Multiple logistic regression analysis showed that the severity of stenosis assessed by measurement of the mitral valve area by echo-Doppler was the most powerful predictor of maternal pulmonary oedema. The other factors were late antenatal presentation, presence of symptoms prior to the index pregnancy and diagnosis of cardiac disease for the first time in the index pregnancy.Conclusion Despite serious disease, women with persistent symptoms treated either by balloon mitral valvulotomy where feasible, or conservatively with close noninvasive monitoring, had a satisfactory fetal and maternal outcome. tent symptoms.

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Section: Discussionmentioning

confidence: 99%

“…Surgical commissurotomy of the mitral valve provided the first dramatic benefit to women who presented with severe noncalcific mitral stenosis in pregnancy 3,4 . Centres with expertise to perform percutaneous balloon mitral valvuloplasty during pregnancy provided similar benefit.…”

Section: Introductionmentioning

confidence: 99%

Mitral stenosis in pregnancy: a four‐year experience at King Edward VIII Hospital, Durban, South Africa

Desai¹,

Adanlawo²,

Naidoo

et al. 2000

BJOG

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Treatment of valvular heart disease during pregnancy for improving maternal and neonatal outcome

Henriquez

Roos‐Hesselink

Schalij

et al. 2011

Cochrane Database of Systematic Reviews

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Maternal Heart Disease

Bitsch

Johansen

Wennevold

et al. 1989

Acta Obstet Gynecol Scand

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Among 87 pregnancies complicated by heart disease, delivered during the decade 1977-86, 70 (81%) had a congenital heart malformation, 7 (8%) an acquired heart disease and 10 (11%) arrhythmias or conduction disturbances. The incidence was 0.3%. The corresponding data from a report from Rigshospitalet during the 1950s were: 42%, 49%, and 9%, respectively, and an incidence of 0.9%. Ventricular septal defect (VSD) and atrial septal defect (ASD) were the most frequent malformations. The women were classified according to the NYHA before, during and after the pregnancy. All women except 4 re-entered their original functional class. In 51 cases, ECG showed completely normal sinus rhythm, while in 36, various degrees of arrhythmia or conduction disturbance were found as well as left or right ventricular hypertrophy and/or strains. Nine infants had congenital defects, 4 of which were a heart malformation (4.6%). One infant died. Gestational duration, weight and perinatal mortality did not differ significantly from that of the general population. Two women died, one of primary pulmonary hypertension and one with a rupture of the thoracic aorta. Rheumatic heart disease is no longer a significant factor in relation to pregnancy in Denmark, but congenital heart disease is still of great importance, because more survive and reach the age of fertility. Today most women can be brought safely through pregnancy, but obstetric, cardiologic and anesthesiologic expertise is still mandatory for a successful course and outcome of pregnancies complicated by heart disease.

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Commissurotomy and pregnancy: A study of 245 cases

Cited by 3 publications

References 13 publications

Mitral stenosis in pregnancy: a four‐year experience at King Edward VIII Hospital, Durban, South Africa

Mitral stenosis in pregnancy: a four‐year experience at King Edward VIII Hospital, Durban, South Africa

Treatment of valvular heart disease during pregnancy for improving maternal and neonatal outcome

Maternal Heart Disease

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