PMID- 12621917
OWN - NLM
STAT- MEDLINE
DCOM- 20030929
LR  - 20121115
IS  - 0870-2551 (Print)
IS  - 0870-2551 (Linking)
VI  - 21
IP  - 12
DP  - 2002 Dec
TI  - Balloon mitral valvuloplasty during pregnancy--our experience.
PG  - 1437-44
AB  - INTRODUCTION: Mitral stenosis is the most common valvular heart lesion found in 
      pregnancy. When severe, it leads to significant maternal and fetal morbidity and 
      mortality, since the hemodynamic adaptations to pregnancy are badly tolerated. 
      Pregnancy can lead to development of heart failure in patients with asymptomatic 
      or even unknown mitral stenosis, as a result of the increased mitral valve 
      pressure gradient caused by the physiologic increase in heart rate and blood 
      volume in pregnancy. When symptoms persist despite optimal medical therapy, the 
      poor prognosis justifies the correction of mitral stenosis during pregnancy. 
      OBJECTIVE: To present our experience in treating severe mitral stenosis in women 
      who develop severe heart failure during pregnancy, using percutaneous balloon 
      mitral valvuloplasty. PATIENTS: From 1996 to March 2002, in our department, 47 
      balloon mitral valvuloplasties were successfully performed in women, three of 
      them pregnant. These were patients with congestive heart failure, New York Heart 
      Association (NYHA) functional class III or IV, at the end of the second trimester 
      of pregnancy, who did not respond positively to drug treatment with diuretics and 
      digitalis. INTERVENTIONS: We performed percutaneous balloon mitral valvuloplasty 
      using the Inoue technique in the three pregnant patients, with success, at around 
      25 weeks of gestation. RESULTS: After the procedure, the patients showed clinical 
      improvement, returning to the NYHA functional class that they were in before 
      becoming pregnant (I-II). The previous mitral valve area was 0.9-1.2 cm2, nearly 
      doubling after valvuloplasty. Mean left atrial pressure decreased on average by 
      42%, and the maximum pressure (V wave) decreased on average by 40%. The mitral 
      valve pressure gradient decreased from 15, 10 and 28 mmHg to 7, 5 and 5 mmHg 
      after valvuloplasty. During the procedure there were no maternal or fetal 
      complications. All patients were discharged 24 to 48 h after valvuloplasty, 
      continuing their pregnancies without complications. One woman had vaginal 
      delivery, and the other two had cesarean sections at 35 weeks of gestation, all 
      without complications with healthy newborns that developed normally. In 
      follow-up, one patient who had moderate mitral regurgitation after valvuloplasty 
      developed severe mitral regurgitation, requiring surgical correction after two 
      years. CONCLUSION: In pregnant patients who have severe mitral stenosis and 
      persistent congestive heart failure symptoms despite conventional medical 
      treatment, when feasible, percutaneous balloon mitral valvuloplasty is the best 
      treatment.
FAU - Salome, Nuno
AU  - Salome N
AD  - Servico de Cardiologia do Centro Hospitalar de Vila Nova de Gaia, Vila Nova de 
      Gaia. nunosalome@netcabo.pt
FAU - Dias, Carla C
AU  - Dias CC
FAU - Ribeiro, Jose
AU  - Ribeiro J
FAU - Goncalves, Manuel
AU  - Goncalves M
FAU - Fonseca, Conceicao
AU  - Fonseca C
FAU - Ribeiro, Vasco Gama
AU  - Ribeiro VG
LA  - eng
LA  - por
PT  - Journal Article
PL  - Portugal
TA  - Rev Port Cardiol
JT  - Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de 
      Cardiologia = Portuguese journal of cardiology : an official journal of the 
      Portuguese Society of Cardiology
JID - 8710716
SB  - IM
MH  - Adult
MH  - *Catheterization
MH  - Female
MH  - Humans
MH  - Mitral Valve Stenosis/*therapy
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/*therapy
EDAT- 2003/03/08 04:00
MHDA- 2003/09/30 05:00
CRDT- 2003/03/08 04:00
PHST- 2003/03/08 04:00 [pubmed]
PHST- 2003/09/30 05:00 [medline]
PHST- 2003/03/08 04:00 [entrez]
PST - ppublish
SO  - Rev Port Cardiol. 2002 Dec;21(12):1437-44.