Percutaneous balloon mitral valvotomy in pregnant patients with tight pliable mitral stenosis

Patel, J. J.; Mitha, Abdul S.; Hassen, Farouk; Patel, Nalin; R, Naidu; Chetty, S; Pillay, Reventheran

doi:10.1016/0002-8703(93)90120-x

Cited by 57 publications

(25 citation statements)

References 8 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: 75%

“…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: 75%

Section: Introductionmentioning

confidence: 99%

Percutaneous mitral commissurotomy in pregnant women – long-term observations

Dąbrowski¹,

Chmielak²,

Dąbrowski³

et al. 2011

pwki

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show abstract

“…However, like in the present study, usually women with mitral stenosis are referred for cardiological follow-up only after the beginning of pregnancy. Facing these facts and the low incidence of complications observed when the balloon mitral valvulotomy technique is used during pregnancy [16][17][18][19][20][21][22][23] , this procedure should be seriously considered for the treatment of pregnant women with mitral stenosis and a greatly reduced mitral valve area, independently of their functional class, particularly if we take into account that acute lung edema can be the first clinical manifestation of mitral stenosis during pregnancy 10,11 . Unfortunately, we did not have the opportunity to eva- luate the influence of important covariables on the associations investigated in this study.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors of rheumatic mitral stenosis during pregnancy and puerperium

Barbosa¹,

Lopes

Feitosa

et al. 2000

Arq. Bras. Cardiol.

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“…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.…”

Section: Mitral Stenosismentioning

confidence: 99%