Mitral valve disease in pregnancy: outcomes and management

Abstract

Summary: Young women may have asymptomatic mitral valve disease which becomes unmasked during the haemodynamic stress of pregnancy. Rheumatic mitral stenosis is the most common cardiac disease found in women during pregnancy. The typical increased volume and heart rate of pregnancy are not well tolerated in patients with more than mild stenosis. Maternal complications of atrial fibrillation and congestive heart failure can occur, and are increased in patients with poor functional class and severe pulmonary artery hypertension. Patients can be diagnosed by echocardiography and symptoms treated with beta-1 antagonists and cautious diuresis. Patients with heart failure unresponsive to treatment can undergo percutaneous balloon mitral valvuloplasty. Labour and delivery goals include reducing tachycardia by adequate pain control and minimized volume shifts. Mitral valve regurgitation, even when severe, is usually very well tolerated in pregnancy as the increase in volume is offset by a decrease in vascular resistance. On the other hand, patients with left ventricular dysfunction, moderate pulmonary hypertension or NYHA functional class III-IV are at increased risk for heart failure and arrhythmias. They may need cautious diuresis and limitations on physical activity during pregnancy, as well as invasive haemodynamic monitoring for labour and delivery. Vaginal delivery is preferred and caesarean section reserved for obstetric indications.

Cardiac Disease in Pregnancy: Value of Echocardiography

“…Mild mitral stenosis (valve area >1.5 cm 2 ) is well tolerated, but moderate and severe stenosis are associated with increased rates of pulmonary edema, supraventricular arrhythmias, and hospitalization. Ideally, women should be diagnosed and evaluated by a multidisciplinary team prior to conception, but frequently patients and physicians are not aware of their disease until symptoms lead to an echocardiogram during pregnancy [28].…”

“…The patient's clinical status and ventricular function prior to pregnancy are most predictive of success. Although cardiac surgery has been performed later in pregnancy, it is rarely indicated except for class III and IV heart failure that is refractory to medical management [28,34]. Echocardiography should be used to assess the ventricular function and the etiology of the regurgitation, particularly for those who develop acute regurgitation and decompensation.…”

At the Heart of the Pregnancy: What Prenatal and Cardiovascular Genetic Counselors Need to Know about Maternal Heart Disease

“…It is very concerning if symptoms of heart failure present in the first trimester, as these will be expected to progressively worsen, and measures must be taken to correct hemodynamic issues as much as possible. As a general rule, pregnant women tolerate volume overload better than pressure overload, thus regurgitant valvular lesions are generally tolerated better than stenotic valvular lesions (Drenthen et al 2010;Tsiaras and Poppas 2009). Left-sided stenotic lesions are at the highest risk for poor maternal outcomes.…”

Anestesi Spinal Dosis Rendah Untuk Pasien Operasi Sesar dengan Stenosis Mitral Berat

“…Antikoagulan warfarin sebaiknya digunakan pada stenosis mitral dengan fibrilasi atrium atau irama sinus dengan kecenderungan pembentukan trombus untuk mencegah fenomena tromboemboli. 6,14,15 Intervensi bedah, reparasi atau ganti katup (komisurotomi) pertama kali diajukan oleh Brunton pada tahun 1902 dan berhasil pertama kali pada tahun 1920. Akhir-akhir ini komisurotomi bedah dilakukan secara terbuka karena adanya mesin jantung-paru.…”