Balloon valvotomy for pregnant patients with severe pliable mitral stenosis using the Inoue technique with total abdominal and pelvic shielding

Abstract

Balloon valvotomy by means of the inoue technique was attempted in seven pregnant (5 to 9 months) patients with severe mitral stenosis; the mean age of the patients was 32 ± 8 years, and all had a two-dimensional echocardiographic mitral valve score of <8. Indications for inoue balloon valvotomy included severe symptomatic mitral stenosis with a Doppler mitral valve area ≤1 cm 2 and heart failure refractory to medical therapy, or absolute contraindications for the use of β-blockade; inoue valvotomy was also indicated for patients who lived a long distance from the hospital. Inoue balloon valvotomy was performed with no angiography and total pelvic and abdominal shielding; the balloon catheter was introduced into the right atrium without the aid of fluoroscopy, which was used for the transseptal puncture. Stepwise two-dimensional echocardiographic Doppler mitral valve dilatation was done. After inoue balloon valvotomy the mean Doppler mitral valve area increased from 0.8 ± 0.1 to 2.0 ± 0.3 cm 2 ( p < 0.01) and by two-dimensional echocardiography from 0.8 ± 0.2 to 1.9 ± 0.3 cm 2 ( p < 0.01), with no significant Doppler residual stenosis (defined as mitral valve area ≤ 1.5 cm 2). The mean total fluoroscopy time was 16 ± 7 minutes. The degree of mitral regurgitation increased in two patients from grade 1+/4+ to grade 2+/4+ and from grade 0+/4+ to grade 2+/4+, respectively. There was no mortality or significant morbidity. Pregnancy was uneventful in all patients, and all were delivered of normal babies without complications. After delivery the mean Doppler mitral valve area was 1.9 ± 0.3 cm 2 with no mitral valve restenosis. We conclude that Inoue balloon valvotomy with total pelvic and abdominal shielding and echocardiography may be a valid therapeutic alternative for pregnant patients with severe symptomatic pliable mitral stenosis.