Effectiveness of percutaneous balloon mitral valvotomy during pregnancy

• Published in: The American journal of cardiology Vol. 68; no. 9; pp. 930 - 934
• Main Authors: Esteves, Cesar A., Ramos, Auristela I.O., Braga, Sergio L.N., Harrison, J.Kevin, Sousa, J.Eduardo M.R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-10-1991; Elsevier
• Subjects: Adolescent; Adult; Biological and medical sciences; Blood Pressure; Cardiology. Vascular system; Catheterization - methods; Endocardial and cardiac valvular diseases; Evaluation Studies as Topic; Female; Heart; Heart Failure - etiology; Heart Failure - therapy; Humans; Medical sciences; Middle Aged; Mitral Valve Stenosis - complications; Mitral Valve Stenosis - therapy; Pregnancy; Pregnancy Complications, Cardiovascular - therapy; Pregnancy Outcome; Prospective Studies; Human; Heart failure; Mitral valve; Cuffed tube; Instrumentation therapy; Cardiovascular disease; Narrowing; Instrumental dilatation; Pregnancy; Treatment; Cardiac valvular disease; Female; Technique
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(91)90411-D

During pregnancy, medically refractory congestive heart failure due to mitral stenosis continues to present a clinical challenge and optimal management remains controversial. Thirteen women underwent balloon mitral valvotomy for control of functional class III or IV congestive heart failure due to mitral stenosis during pregnancy. The mean gestational age at the time of valvotomy was 25 ± 6 weeks. Percutaneous balloon mitral valvotomy was performed successfully in all patients. No maternal or fetal mortality occurred. The mean mitral valve area assessed by Doppler echocardiography increased from 0.9 ± 0.3 cm
2 before to 2.1 ± 0.3 cm
2 after valvotomy. The mean mitral valve gradient decreased from 20 ± 7 to 4 ± 2 mm Hg. This was associated with a decrease in the pulmonary artery systolic pressure from 62 ± 24 to 32 ± 14 mm Hg. Currently, 12 of the 13 patients have delivered at an average gestational age of 38 ± 0.5 weeks. Symptoms of congestive heart failure improved in all women and all were in New York Heart Association functional class I at the time of delivery. One patient is still pregnant and symptom free. Eleven singlet pregnancies resulted in the birth of full-term, healthy infants (mean birth weight 3.2 kg). The woman carrying a twin pregnancy improved from New York Heart Association class IV to class I after balloon mitral valvotomy but delivered prematurely at 32 weeks. The premature twin infants weighed 1.0 and 1.5 kg and died from respiratory failure at 48 hours.
Percutaneous balloon mitral valvotomy can be performed safely during pregnancy and is effective in relieving symptoms of severe congestive heart failure. Balloon mitral valvotomy offers an effective alternative for the pregnant patient with severe mitral stenosis when congestive heart failure is not controlled by conventional medical treatment. The risk to the fetus appears lower than previous reports of surgical commissurotomy performed during pregnancy.