Original Article

Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis

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

Wong MC, Clark DJ, Horrigan MC, Grube E, Matalanis G, Farouque HM. Advances in percutaneous treatment for adult valvular heart disease. Intern Med J. 2009;39 (7):465–74

Glantz JC, Pomerantz RM, Cunningham MJ, Woods JR., Jr Percutaneous balloon valvuloplasty for severe mitral stenosis during pregnancy: a review of therapeutic options. Obstet Gynecol Surv. 1993;48 (7):503–8.

Maureen P. Malee Medical and Surgical Complications of Pregnancy. James R., Md. Scott, Ronald S., Md. Gibbs, Beth Y., Md. Karlan, Arthur F., Md. Haney, David N. Danforth. Danforth's Obstetrics and Gynecology, 9th Ed: ByLippincott Williams & Wilkins Publishers; 9th edition (August 2003) Chapter 17. P: 286.

Carole A. Warnes, Pregnancy and Heart Disease. Douglas L. Mann, MD, Douglas P. Zipes, MD, Peter Libby, MD, Robert O. Bonow, MD, Eugene Braunwald, MD. BRAUNWALD’S HEART DISEASE. A Textbook of Cardiovascular Medicine. tenth edition. Elsevier SAUNDERS. 1600 John F. Kennedy Blvd. Ste. 1800. Philadelphia, PA 1760.

Seyfollah Abdi, Negar salehi, Babak Ghodsi, Hossein Ali Basiri, Mahmoud Momtahen, Ata Firouzi, Hamid Reza Sanati, Farshad Shakerian, Mohsen Maadani, Homan Bakhshandeh, Soheila Chamanian, Mitra Chitsazan, and Anoushiravan Vakili-Zarch. Immediate Results of Percutaneous Trans-Luminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis. Clin Med Insights Cardiol. Feb 9, 2012; 6: 35–39.

Palma Shaw, MDa, , Audra Duncan, MDb, Ageliki Vouyouka, MDc, Kathleen Ozsvath, MDd. Radiation exposure and pregnancy. Journal of Vascular Surgery. Volume 53, Issue 1, Supplement, January 2011, Pages 28S–34S.

Hameed, Afshan B. MD; Mehra, Anilkumar MD; Rahimtoola, Shahbudin H. MB, FRCP. The Role of Catheter Balloon Commissurotomy for Severe Mitral Stenosis in Pregnancy. Obstetrics & Gynecology Issue: Volume 114(6), December 2009, pp 1336-1340.

Rick A. Nishimura, Catherine M. Otto, Robert O. Bonow, Carlos E. Ruiz, Blase A. Carabello, Nikolaos J. Skubas, John P. Erwin III, Paul Sorajja, Robert A. Guyton, Thoralf M. Sundt III, Patrick T. O’Gara, James D. Thomas, 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons.Circulation journal of American Heart Association. 2017 May; PP 32-34.

Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. 1984 Mar;87(3):394-402.

Noor-ul-Hadi, Adnan Mehmood Gul, Fazal-Ghafoor, Syed Tahir Shah, Abdul Wali, Syed Javed Shah, Syed Sadiq Shah, Saeed Ali, Rehman Said, Kashifulla, Amber Ashraf, Mohammad Hafizullah. Radiation exposure in different cardiac cathterization procedures in cathlab. Cardiology Department, Postgraduate medical institute, Lady Reading Hospital Peshawar, Pakistan. J Ayub Med Coll Abbottabad 2013; 25(3-4).

Routray SN, Mishra TK, Swain S, Patnaik UK, Behera M. Balloon mitral valvuloplasty during pregnancy. Int J Gynaecol Obstet 2004; 85:18–23.

M. Ben Farhat, H. Gamra, F. Betbout, F. Maatouk, M. Jarrar, F. Addad, M. Tiss, S. Hammami, I. Chahbani, and R. Thaalbi. Percutaneous balloon mitral commissurotomy during pregnancy. Heart. 1997 Jun; 77(6): 564–567.

Orrange SE, Kawanishi DT, Lopez BM, Curry SM, Rahimtoola SH. Actuarial outcome after catheter balloon commissurotomy in patients with mitral stenosis. Circulation 1997; 95:382–9.

Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002; 105:1465–71.

Esteves CA1, Munoz JS, Braga S, Andrade J, Meneghelo Z, Gomes N, Maldonado M, Esteves V, Sepetiba R, Sousa JE, Palacios IF. Immediate and long-term follow-up of percutaneous balloon mitral valvuloplasty in pregnant patients with rheumatic mitral stenosis. Am J Cardiol. 2006 Sep 15;98(6):812-6.

Patel JJ1, Mitha AS, Hassen F, Patel N, Naidu R, Chetty S, Pillay R. Percutaneous balloon mitral valvotomy in pregnant patients with tight pliable mitral stenosis. Am Heart J. 1993 Apr; 125 (4):1106-9.

Ramondo A1, Barchitta A, Budano L, Lupia M, Chioin R. Mitral valvuloplasty in pregnancy: a report of 4 cases. Ital Cardiol. 1998 Aug; 28(8):873-7.

Gulraze A, Kurdi W, Niaz FA, and Fawzy ME. Mitral balloon valvuloplasty during pregnancy:The long term up to 17 years obstetric outcome and childhood development. Pak J Med Sci. 2014 Jan-Feb; 30(1): 86–90.

Martínez-Reding J1, Cordero A, Kuri J, Martínez-Ríos MA, Salazar E. Treatment of severe mitral stenosis with percutaneous balloon valvotomy in pregnant patients. Clin Cardiol. 1998 Sep; 21(9):659-63.

Rezvanie Salehi, Naser Aslanabadi, Simin Taghavi, Leili Pourafkari, Shahla Imani and Mohamad Goldust. Percutaneous Balloon Mitral Valvotomy During Pregnancy. Pakistan Journal of Biological Sciences, 16: 198-200. March 16, 2013.

Rebecca S. Norrad, Omid Salehian. Management of Severe Mitral Stenosis During Pregnancy. Circulation. 2011; 124:2756-2760.

Kinsara AJ, Ismail O, Fawzi ME. Effect of balloon mitral valvoplasty during pregnancy on childhood development. Cardiology. 2002; 97(3):155-8.

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IssueVol 14 No 1 (2019): J Teh Univ Heart Ctr QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v14i1.650
Keywords
Heart valve diseases Mitral valve stenosis Balloon valvuloplasty Pregnancy
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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. 2019;14(1):12-17.