Treatment of severe mitral stenosis with percutaneous balloon valvotomy in pregnant patients

Abstract

HLickgroiinti: Pregnancy can cause life-threatening coniplications in women with mitral stenosis. Frequently. there is an urgent need to increase the mitral valve area mechanically. In selected cases, percutaneous initral balloon vulvotomy (PMBV) has emerged as a safe andeft'ective alternative to surgical commissurotom y. Hypotfwsis: The study evaluates the effects of PMRV by the Inoue technique in nine pregnant patients with severe symptomatic initral stenosis. Methods: The patients were in New York Heart Association (NY HA) functional class I1 to JV and had echocardiographic scores of< 8. The mean gestational age was 74.8 .+ 6.1 weeks. The patient's pelvic and abdominal regions were covered with a lead apron to protect the fetus from radiation. A stepwise dilatation technique was used. Fluoroscopy time was kept to 10 to 15 min. h'iw/ts: One patient developed severe niitral regurgitation requiring emergency valve replacement. The remaining eight patients showed marked immediate symptomatic and hemodynamic improvement. After dilatation. the transniitral pressure gradient decreased from 20.8 2 6.5 to 7.3 f I .4 mnHg (p = 0.00 I) and the calculated niitral valve area increased from 0.9 +. 0.1 to 1.8 +. 0.4 (p < 0.00 I). All patients had uneventful term deliveries of norinal babies. On follow-up they were in NYHA functional class I. Cow/usiom: Percutaneous mi tral balloon valvotomy is a safe and effective procedure for selected pregnant patients with severe initral stenosis. The procedure is well tolerated by the fetus. Severe mitral regurgitation requiring immediate surgery may occur occasionally. The possible harmful effects to the fetus from its exposure to radiation during PMBV are unknown.

Clinical and echocardiographic assessment of pregnant women with valvular heart diseases—maternal and fetal outcome

“…In the cases when pharmacological therapy proves ineffective in pregnants with mitral valve stenosis, percutaneous mitral balloon valvuloplasty is currently recommended as a more viable and much safer procedure, although not entirely devoid of complications [10,11]. The calcifications of the valves render the balloon valvuloplasty impossible, so surgical valve replacement is required.…”

Anesthetic management for emergency cesarean section in a patient with severe valvular disease and preeclampsia

“…8 Percutaneous mitral balloon valvuloplasty is currently recommended as a safe and viable procedure in patients with prosthetic valves when pharmacological therapy is ineffective during pregnancy. 9,10 The decision to proceed with cesarean section rather than mitral valvuloplasty was made because of the concern that the patient might acutely decompensate during this procedure. If this occurred, then emergency delivery of the fetus might have been difficult and lengthy.…”

Fetomaternal outcome among women with mitral stenosis after balloon mitral valvotomy

“…The cooperation of specialists including cardiologists, radiologists, cardiovascular surgeons, and physicians, among others, coupled with the development of modern drugs and improvements in socioeconomic status, has reduced fetomaternal morbidity and mortality. Balloon mitral valvotomy has been performed for severe mitral stenosis during pregnancy with marked symptomatic relief and excellent fetomaternal outcomes [8–10]. However, the facilities needed to perform BMV might not be available in many hospitals, especially in low‐resource countries, and there is a reluctance to perform any surgery during pregnancy [11].…”