Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis

  • Ata Firouzi Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
  • Niloufar Samiei Heart valve disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
  • Somayyeh Ahmadi Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
  • Nasim Naderi Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
  • Parham Sadeghipour Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
  • Hamid Reza Sanati Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
  • Fahimeh Kashfi Heart valve disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
  • Roya Sattarzadeh Echocardiography Laboratory, Department of Cardiovascular Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Sedigheh Hantoushzadeh Maternal Fetal Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Maryam Bayat Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
  • Sanaz Pourtaghi Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
  • Mohsen Nasiri Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
Keywords: Heart valve diseases, Mitral valve stenosis, Balloon valvuloplasty, Pregnancy

Abstract

Background: Mitral stenosis tends to worsen during pregnancy because of the increase in the cardiac output and the heart rate. In nonresponders to medical therapy, percutaneous transluminal mitral commissurotomy (PTMC) may be performed when there is a suitable valvular anatomy. In this study, we aimed to investigate the clinical and fetal outcomes of pregnant women with mitral stenosis who underwent PTMC.

Methods: Thirty-one patients undergoing PTMC during pregnancy were enrolled in this study. The mitral valve area (MVA), the transmitral valve mean gradient (MVMG), and the severity of mitral regurgitation were assessed pre- and postprocedurally by transthoracic and transesophageal echocardiography. The radiation time was measured during the procedure. The patients were followed up during pregnancy, and the neonates were monitored for weight, height, the head circumference, the birth Apgar score, and the adverse effects of radiation for at least 12 months.

Results: PTMC was successfully performed on 29 (93.5%) patients. No maternal death or pulmonary edema was reported. The mean MVA significantly increased (from 0.73±0.17 cm2 to 1.28±0.24 cm2; P<0.001), and the mean MVMG significantly decreased (from 19.62±5.91 mmHg to 8.90±4.73 mmHg; P<0.001) after the procedure. A significant decrease in the systolic pulmonary artery pressure was also detected. Mitral regurgitation did not increase in severity in 16 (51.6%) patients. There was no significant relationship between the Apgar score, weight, height, and the head circumference at birth and at the radiation time.

Conclusion:  In our series, PTMC during pregnancy was a safe and effective procedure. Lowering the radiation time with low frame-count techniques confers a significant decrease in radiation-related complications.

References

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Published
2019-01-16
How to Cite
1.
Firouzi A, Samiei N, Ahmadi S, Naderi N, Sadeghipour P, Sanati HR, Kashfi F, Sattarzadeh R, Hantoushzadeh S, Bayat M, Pourtaghi S, Nasiri M. Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis. J Tehran Heart Cent. 14(1):12-17.
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Original Article(s)