[Mitral commissurotomy during pregnancy]

The physiological hemodynamic changes of the circulation during pregnancy are the main cause of mitral stenosis (MS) decompensation. In pregnant women with MS, the blood volume increase, tachycardia and the obstacle to left ventricular filling are responsible of post-capillary pulmonary hypertension (PF). This hemodynamic stress associated to other conditions can trigger acute pulmonary edema or even cardiogenic shock leading eventually to an unacceptable maternal and fetal death. The percutaneous mitral commissurotomy (PMC) has been tested with success during pregnancy, with excellent short- and mid-term results. We report our experience on seventy patients requiring PMC during the third trimester of pregnancy, between March 1998 and June 2006. The PMC was successful in sixty nine out of seventy patients. All of them improved their NYHA class of that least one stage. None of them kept a residual mitral surface<1.5 cm2. The PMC permitted a spectacular clinical and hemodynamic improvement, and the course of pregnancy until end of term occurred in almost all cases.