Mitral Stenosis In Pregnancy Research Articles

Management of mitral stenosis in pregnancy

Management of mitral stenosis in pregnancy

Immediate maternal and fetal outcome following percutaneous mitral valve balloon commissurotomy: a 6-year single-center experience from sub-Saharan Africa.

Mitral stenosis is the most common valvular heart disease during pregnancy. When severe, it leads to significant maternal and fetal morbidity and mortality. Percutaneous mitral valve balloon commissurotomy can be performed during pregnancy, and the present study aimed to describe the immediate maternal and fetal outcomes after percutaneous mitral valve balloon commissurotomy was done in a cohort of 23 pregnant patients with severe mitral stenosis in Addis Ababa, Ethiopia. Included in the current study were all pregnant mothers who had severe rheumatic mitral valve stenosis and who underwent percutaneous mitral valve balloon commissurotomy at the Cardiac Center of Ethiopia over 6-year period. Data were collected through chart abstraction using a structured proforma and then analysed using STATA version 13.0. Median gestational age was 22 weeks and percutaneous mitral valve balloon commissurotomy was successful resulting in a significant increase in the mean mitral valve area of the group from 0.78 ± 0.20 cm2 to 1.89 ± 0.31 cm2 (p < 0.001). The mean mitral valve inflow gradient of the group was 23.95 ± 6.27 mmHg and 6.80 ± 2.44 mmHg, respectively, before and after the percutaneous mitral valve balloon commissurotomy procedure (p < 0.001). Post-procedure, there was no significant increment in mitral valve incompetence. The mean pulmonary artery pressure of the group decreased from 77.68 ± 23.19 mmHg to 42.31 ± 9.95 mmHg (p < 0.001). There was no fetal or maternal death following the procedure. Pregnancy ended at term gestation for 19/23 (82.6%) of the mothers and the mean birth weight of the neonates was 2800 g. Percutaneous mitral valve balloon commissurotomy procedure can safely be done for severe symptomatic rheumatic mitral stenosis in pregnancy in our setting.

Z. J. Lusk. Mitral stenosis in pregnancy (New-York Medical Journal, 1893, January 14). Contraction of venous opening in pregnant women

The author gives several cases from his practice, in which mitral stenosis was a serious complication of pregnancy. According to the author, the doctor must set himself an immutable rule - to make a thorough examination of the heart in every case of pregnancy that comes across to him. If there is a narrowing of the venous opening before the 5th month of pregnancy, it is rational to resort to an artificial miscarriage.

Mitral Stenosis in Pregnancy: A Comprehensive Review of a Challenging Cardio-Obstetric Clinical Entity.

Mitral stenosis is one of the most commonly encountered valvular heart diseases during pregnancy, the majority are rheumatic in origin and poorly tolerated due to cardiocirculatory changes that occur during pregnancy, labor and postpartum. The distinctive physiological events that arise during pregnancy and labor and the influence of mitral stenosis are tackled in this article. Through PUBMED and MEDLINE searches, we reviewed the literature of the last decade as well as the recommendations from guidelines of high-impact worldwide. Cardiac decompensation usually takes place late in pregnancy as the hemodynamic burden of pregnancy become more pronounced as well as after delivery due to an abrupt increase of preload secondary to autotransfusion and aorto-caval decompression. The maternal and fetal complications correlate with the New York Heart Association (NYHA) functional classification and the grade of mitral stenosis. Medical therapy should be tried first. If symptoms continue in spite of optimal medical therapy, invasive procedures are recommended. Several studies revealed that vaginal delivery under epidural anesthesia is endurable and of low-risk unless obstetrically contraindicated. Pregnancy and mitral stenosis remain a complex entity and a well-known trigger of maternal mortality during pregnancy and peri-partum period if not managed adequately. A good appreciation and recognition of the physiology of pregnancy and its impact on the pre-existing mitral stenosis and the presence of a specialized multidisciplinary team to handle such cases significantly decrease maternal and fetal mortality and morbidity.

Severe mitral stenosis in term pregnancy: management by simultaneous cesarean section and mitral valve replacement. Case report

A 38-year-old woman in the 37th week of pregnancy was admitted for acute presentation of severe cough and aggravated dyspnea. She was previously diagnosed with rheumatic heart disease (RHD) at the age of 31. During the present pregnancy, she reported at 37 weeks and had RHD, severe mitral stenosis, secondary pulmonary hypertension, and heart failure. As a consequence, the patient underwent an emergency cesarean section followed by reoperative mitral valve replacement, which was successfully under a cardiopulmonary bypass (CPB). In this report, the authors present the successful experience of management of severe mitral stenosis in pregnancy.

Emergency LSCS for moderate to severe mitral stenosis in pregnancy- A comparision between graded epidural vs general

Mitral stenosis is the most common heart disease associated with pregnancy in developing countries like India in spite of the decrease prevalence of rheumatic heart disease. majority of deaths occur during labour or in the peripartum period due to unique physiological change in pregnancy in a fixed cardiac output state. 50 parturients with moderate to severe mitral stenosis under-going caeserean section were devided into two groups of 25 each. one group received general anaesthesia and the other group received graded epidural. It was found that both the groups maintained the vitals quiet well. But the was a higher incidence of pulmonary oedema in general anaesthesia group (9out of 25) as compared to graded epidural group (3 out of 25) and hence the duration of ICU stay was prolonged in general anaesthesia group. The fetal outcome was also better in graded epidural group as compared to the general anaesthesia group (APGAR score was high in graded epidural group, P value≤0.001).

OUTCOMES OF PERCUTANEOUS TRANSLUMINAL MITRAL COMMISSUROTOMY (PTMC) FOR SEVERE MITRAL STENOSIS IN PREGNANCY

Objective: To know short term outcomes of PTMC for severe isolated mitralstenosis in pregnancy. Methodology: This observational study was performed in Cardiology Unit ofLady Reading Hospital Peshawar from January 2003 to December 2014. Allpatients with symptomatic severe isolated mitral stenosis with no more thanmoderate degree mitral regurgitation were included in the study. They werefollowed till delivery. Results: A total number of 36 pregnant patients undergoing PTMC for isolatedsevere mitral stenosis were included in the study. Mean age was 29±6.3 years.Mild mitral regurgitation was found in 18(50%) of patients, moderate mitralregurgitation in 3(8.3%) while there was no mitral regurgitation in 15(41.7%)patients. Mean mitral valve area was 0.8±0.36 cm . Mean mitral valve gradientwas 23±11 mm of Hg. There mean left atrium size was 4.7±1.2cm. Meanejection fraction was 58.43%. Mean pulmonary artery pressure was 45.8±16.4mmof Hg. PTMC was performed in second trimester in 32(88.88%) patients andin third trimester in 4(11.11%) patients. PTMC was successful in 33(91.6%).Post PTMC mitral valve area was 1.8±0.82cm . The mean mitral valve gradientwas 4±3.2 mm of Hg. Mean left atrium size was 4.61± 2.34 cm. Mild mitralregurgitation was found in 17(47.22%). Moderate mitral regurgitation was foundin 5(13.8%) of patients. Acute severe mitral regurgitation occurred in 1(2.7%)patient, for which emergency mitral valve replacement was arranged but expired.One (2.7%) had still birth. The mean fluoroscopy time was 9.3±7.2 minutes. Conclusion: PTMC is safe and effective procedure for severe symptomatic mitralstenosis in pregnant patients. KeyWords: Percutaneous Transluminal Mitral Commissurotomy (PTMC), MitralStenosis, Pregnancy

Anesthetic management of cesarean section with mitral stenosis and respiratory tract infection

Mitral stenosis in pregnancy is poorly tolerated because of the pregnancy induced physiological changes in the cardiovascular system. Our patient had presented with cardiac failure in 5 ^th month of gestation due to valve area of 0.8 cm ² . She underwent commissurotomy and was asymptomatic with valve area of 1.6 cm ² until term when she developed lower respiratory tract infection. Anesthetic management of emergency caesarean section in this patient is discussed where neuraxial block is not well-tolerated, and general anesthesia is associated with increased morbidity in the presence of reactive airways.

Pulmonary edema due to mitral stenosis in pregnancy: A Case Report

SUMMARY Mitral stenosis is a valve disease, that creates the most trouble during pregnancy and birth process. Plasma volume increases due to sodium and water retention during pregnancy and the second trimester of pregnancy it reaches the maximum level. At the first trimester of pregnancy, normal cardiac output increases by 30 to 40% and this condition causes significant hemodynamic changes in patients with mitral stenosis. Pulmonary edema occurs rapidly with high left atrial pressure due to increase of preload. ‹t is noted that acute pulmonary edema is the primary cause on maternal mortality in pregnant women with mitral stenosis . Clinical signs are becoming evident, especially after the 12th week. Despite the best conservative treatment, maternal and infant mortality can be seen.In this case, we present a rare occurrence of pulmonary edema following dispne due to mitral stenosis in a 19 years old pregnant at 29th week of the first pregnancy.

The Role of Catheter Balloon Commissurotomy for Severe Mitral Stenosis in Pregnancy

Mitral stenosis is one of the more commonly seen valve lesions encountered in pregnancy. The pathophysiologic implications, management strategies, and a comprehensive review of literature over the past 20 years for optimal timing of catheter balloon commissurotomy during pregnancy are discussed. Mechanical relief of obstruction is indicated for cases of severe symptomatic mitral stenosis in pregnancy refractory to medical therapy. Catheter balloon commissurotomy is the procedure of choice in a select group of these patients with suitable valve morphology.

Estenosis mitral en gestante. A propósito de un caso

Summary We present the case of a patient who was diagnosed as having severe to moderate mitral stenosis during gestation, following an acute dyspneic episode. We then discuss the effects of mitral stenosis in pregnancy.

Mitral stenosis in pregnancy: a four-year experience at King Edward VIII Hospital, Durban, South Africa.

To evaluate prospectively mitral stenosis in pregnancy with emphasis on women with persistent symptoms. King Edward VIII Hospital, a tertiary referral obstetric unit. One hundred and twenty-eight consecutive women with mitral stenosis. The mean age was 27 years and 38 women (30%) were primigravidae. Seventy-eight (61%) women had their first cardiac evaluation in the third trimester. Fifty-four women (42%) of these women had mitral stenosis diagnosed for the first time in the index pregnancy. Twenty-nine (23%) had a previous mitral valvulotomy. Nineteen women (15%) developed hypertension during pregnancy, 10 of whom had pre-eclampsia. Sixty-three women (49%) had a mitral valve area of < or = 1.2 cm2 with 11 having critical mitral stenosis (mitral valve area < or = 0.8 cm2). Atrial fibrillation was present in 12 women. Most women (87%) required medical therapy to control the heart rate. OUTCOME IN PERSISTENT SYMPTOMATIC WOMEN: Intervention was considered in 37 women (29%) who remained symptomatic, 11 (9%) of whom had a calcified mitral valve. The remaining 26 women were scheduled for balloon mitral valvulotomy during pregnancy, 20 of whom had balloon mitral valvulotomy with good effect (16 antepartum; 4 postpartum). In seven women, scheduled balloon mitral valvulotomy was not performed because of advanced preterm labour (n = 5), fetal distress (n = 1) and preterm labour with fetal distress (n = 1). These seven, together with the 11 with calcific mitral stenosis, were managed conservatively with good outcome. MATERNAL COMPLICATIONS: Fifty-one percent had maternal complications, the majority occurring at their initial admission to hospital. Pulmonary oedema was the most frequent. Multiple logistic regression analysis showed that the severity of stenosis assessed by measurement of the mitral valve area by echo-Doppler was the most powerful predictor of maternal pulmonary oedema. The other factors were late antenatal presentation, presence of symptoms prior to the index pregnancy and diagnosis of cardiac disease for the first time in the index pregnancy. Despite serious disease, women with persistent symptoms treated either by balloon mitral valvulotomy where feasible, or conservatively with close noninvasive monitoring, had a satisfactory fetal and maternal outcome.

Percutaneous Balloon Valvuloplasty for Severe Mitral Stenosis in Pregnancy

Four pregnant women with mitral stenosis who did not respond to medical therapy underwent successful percutaneous balloon valvuloplasty with complete resolution of their symptoms. Their clinical features and echocardial and hemodynamic data are presented. The procedures and the remainder of their pregnancy were uncomplicated. Percutaneous balloon valvuloplasty of the mitral valve is a safe and effective alternative to surgical therapy if medical management is unsuccessful.

Percutaneous mitral commissurotomy for severe mitral stenosis during pregnancy

Percutaneous mitral commissurotomy was performed in 27 pregnant females aged 24.9 +/- 3.14 years (range 20-30 years) with severe mitral stenosis at 22.2 +/- 4.3 weeks (range 18-32 weeks) of gestation. All patients were in New York Heart Association functional class IV at the time of procedure. The procedure was performed using the flow guided Inoue balloon in 25 patients and double balloon technique in 2 patients. Percutaneous mitral commissurotomy was successful in 26 patients. The mitral valve area assessed by Doppler echocardiography (pressure half time) increased from 0.78 +/- 0.19 cm2 (range 0.5-1.0 cm2) to 2.2 +/- 0.12 cm2 (range 1.9-2.6 cm2) (P < 0.001). The mean mitral gradient decreased from 30.5 +/- 7.6 mm Hg (range 22.5-41.4 mm Hg) to 6.1 +/- 2.6 mm Hg (range 4.2-12.3 mm Hg) (P < 0.001). The end diastolic gradient decreased from 28.3 +/- 4.2 mm Hg (range 23-37 mm Hg) to 2.8 +/- 1.5 mm Hg (range 0-5 mm Hg) (P < 0.001). The total fluoroscopy time was 5.6 +/- 2.2 min (range 2.7-8.9 min). Mitral regurgitation increased by one grade in 7 patients. One patient developed severe mitral regurgitation with anterior mitral leaflet tear needing immediate mitral valve replacement. Twenty-six patients improved to New York Heart Association class I after the procedure. Twenty-four patients had full-term, normal delivery and gave birth to healthy infants. The patients were followed up for 1-36 months (mean 16.6 +/- 7.8 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous balloon mitral valvotomy in pregnant patients with tight pliable mitral stenosis

Percutaneous balloon mitral valvotomy was attempted in severely symptomatic (New York Heart Association class III or IV) pregnant patients (mean age 30 years) with tight mitral stenosis. Nineteen patients were pregnant (mean gestation 30 weeks, range 26 to 34) and one patient was in the immediate postpartum period. All patients had undergone a trial of diuretic therapy and 16 were also taking atenolol. Percutaneous valvotomy was performed with the inoue catheter (18 patients) or the Schneider-Medintag bifoil (2 × 19 mm) balloon catheter (2 patients). The fluoroscopy time was 9.2 ± 3.4 minutes. After percutaneous valvotomy the mean mitral gradient decreased from 17.9 ± 6.2 to 5.9 ± 2.4 mm Hg ( p < 0.001). The mitral valve area (pressure half time) increased from 0.8 ± 0.2 to 1.7 ± 0.2 cm 2 ( p < 0.001). These hemodynamic changes were accompanied by immediate symptomatic improvement by at least one New York Heart Association functional grade in all patients. Moderate (3+) mitral regurgitation developed in one patient. Eighteen patients had normal infants delivered vaginally at term without assistance, and one patient had a normal infant deliveredy by cesarean section at 35 weeks' gestation. We conclude that percutaneous balloon mitral valvotomy for pliable mitral stenosis in pregnancy is safe for both the mother and fetus. We recommend that it be performed in symptomatic patients with tight mitral stenosis so as to avoid hemodynamic complications in the latter stages of pregnancy.

Alfentanil for urgent Caesarean section in a patient with severe mitral stenosis and pul-monary hypertension

We present the case of a parturient with severe mitral stenosis and pulmonary hypertension who received general anaesthesia using alfentanil for urgent Caesarean section. Alfentanil promoted haemodynamic stability and allowed immediate postoperative extubation. Epidural morphine provided postoperative analgesia. This combination permitted early ambulation and prevention of thromboembolism. A disadvantage of this technique, neonatal respiratory depression, was promptly reversed with a single dose of naloxone. The anaesthetic management of mitral stenosis in pregnancy is discussed and the neonatal pharmacokinetics of maternally administered alfentanil are presented.

Beta blockers can manage mitral stenosis in pregnancy

Beta blockers can manage mitral stenosis in pregnancy

The Internist and Mitral Stenosis in Pregnancy

The internist and obstetrician have usually managed the pregnant patient in heart failure as a result of mitral stenosis solely by medical measures. This has been based on the experiences and on the literature of the past and has not given proper consideration to the surgical correction of mitral stenosis. This case report exemplifies the problem the internist may encounter relative to the use and proper timing of mitral-valve surgery in the pregnant cardiac. Furthermore, it emphasizes that the surgical correction of mitral stenosis can be lifesaving, even in a moribund patient. <h3>Report of Case</h3> A 25 year old white female was first seen at Wesley Hospital in April of 1961 (Fig 1). Three days earlier she had experienced disabling shortness of breath, orthopnea, and dependent edema. The patient was five months pregnant and had had no prior difficulty. On the basis of four episodes of arthralgia between the ages

The internist and mitral stenosis in pregnancy

The internist and mitral stenosis in pregnancy

A surgical approach to the treatment of mitral stenosis in pregnancy: A preliminary report

A surgical approach to the treatment of mitral stenosis in pregnancy: A preliminary report