Percutaneous balloon mitral commissurotomy during pregnancy

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Maternal-Fetal Medicine

Background:

• Severe mitral stenosis poses significant risks during pregnancy.
• Medical management alone is often insufficient for symptomatic pregnant patients.
• Percutaneous balloon mitral commissurotomy offers a less invasive treatment option.

Purpose of the Study:

• To assess the efficacy and safety of percutaneous balloon mitral commissurotomy (PBMC) in pregnant women with severe mitral stenosis.
• To evaluate maternal and fetal outcomes following PBMC during pregnancy.
• To determine the long-term impact on children born to mothers who underwent the procedure.

Main Methods:

• Retrospective analysis of 44 pregnant patients undergoing PBMC for severe mitral stenosis.
• Inclusion of clinical, hemodynamic, and echocardiographic data pre- and post-procedure.
• Assessment of pregnancy and neonatal outcomes, with follow-up on infant development.

Main Results:

• Successful commissurotomy in all patients, with significant improvements in hemodynamic parameters (reduced atrial pressure, mitral gradient; increased cardiac output and valve area).
• No maternal or fetal mortality; one case of severe mitral regurgitation requiring valve replacement.
• All deliveries were at full term; most infants were normal, with minor hypotrophy in three cases near term. Long-term child growth was normal.

Conclusions:

• Percutaneous balloon mitral commissurotomy is the preferred treatment for severe, pliable mitral stenosis in pregnant women refractory to medical therapy.
• The procedure is safe and effective, leading to favorable maternal and fetal outcomes.
• PBMC ensures good long-term development in children born after the procedure.