Percutaneous balloon mitral commissurotomy during pregnancy

Area of Science:

• Cardiology
• Obstetrics
• Interventional Cardiology

Background:

• Severe mitral stenosis poses significant risks during pregnancy, often leading to heart failure symptoms.
• Conventional medical therapy may be insufficient for symptomatic pregnant patients with severe mitral stenosis.
• Surgical commissurotomy carries higher risks in pregnant patients compared to non-pregnant individuals.

Purpose of the Study:

• To evaluate the safety and efficacy of percutaneous balloon mitral commissurotomy (PBMC) in pregnant women with severe mitral stenosis.
• To assess the impact of PBMC on hemodynamic parameters and functional status in this patient population.
• To determine the fetal and maternal outcomes following PBMC during pregnancy.

Main Methods:

• PBMC was performed using the Inoue balloon in 16 pregnant women with severe mitral stenosis.
• Patients were in New York Heart Association (NYHA) functional class III or IV despite maximal medical therapy.
• Hemodynamic parameters, valve area, pressure gradients, and clinical outcomes were assessed pre- and post-procedure.

Main Results:

• PBMC significantly increased mitral valve area (0.9 to 1.8 cm2) and decreased pressure gradients and pulmonary artery pressure (p < 0.05).
• All patients showed clinical improvement to NYHA functional class I or II.
• 14 of 16 patients continued pregnancies to term with healthy infants; two had premature deliveries with neonatal mortality due to respiratory distress.

Conclusions:

• PBMC is a safe and effective procedure for pregnant women with severe mitral stenosis and heart failure symptoms refractory to medical treatment.
• The procedure leads to significant hemodynamic improvement and symptom relief with acceptable maternal and fetal outcomes.
• PBMC offers a lower-risk alternative to surgical commissurotomy during pregnancy, with no observed immediate detrimental radiation effects on the fetus.