Symptomatic Mitral Stenosis Research Articles

Conventional Surgery for Early and Late Symptomatic Mitral Valve Stenosis After MitraClip® Intervention: An Institutional Experience With Four Consecutive Patients

Surgical mitral valve repair is the gold standard for treatment of mitral regurgitation. Recently, the transcatheter treatment of mitral regurgitation with the MitraClip® device (Abbot Vascular Structural Heart, Menlo Park, CA) has demonstrated promising results in treating patients not amenable for surgical correction of mitral valve regurgitation. Most patients reported in the literature requiring surgical bailout after MitraClip treatment presented with residual or recurrent mitral valve regurgitation. Mitral valve stenosis after MitraClip treatment has been rarely reported. From February 2010 to December 2014, four patients out of 165 patients who underwent MitraClip therapy developed symptomatic mitral valve stenosis (2.4%) and needed surgical correction. Data of the four patients were reviewed retrospectively. Follow-up data were obtained from each patient's general practitioner/cardiologist by phone calls and facsimile and were complete in all patients. All four patients were treated with ≥ 2 MitraClip (MC) devices during their initial presentation. All four patients underwent MV replacement with a tissue valve. The postoperative course was uneventful and there was no 30-day mortality. At 6-month follow-up, all patients were alive and in NYHA class I-III. Placement of multiple clip devices may lead to slightly elevated transmitral gradients. This may not necessarily interpret into symptomatic mitral stenosis. However, in some cases this is possible. Caution should be exercised at this phase of the learning curve of the percutaneous MC treatment, especially in use of multiple MC devices.

Acute effect of treatment of mitral stenosis on left atrium function.

Aim:Peak atrial longitudinal strain (PALS) is used to evaluate left atrium (LA) function in patients with mitral stenosis (MS), before and after percutaneous transmitral commissurotomy (PTMC) and mitral valve replacement (MVR).Methods:Patients with severe symptomatic MS, who were referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery or PTMC from October of 2014 to October of 2015, were included in the study.Result:The peak systolic global LA strain improved post-PTMC (P < 0.001) and post-MVR (P = 0.012). This difference was statistically highly significant.Conclusion:PALS is impaired in patients with severe symptomatic MS and improved acutely after treatment and may be a good indicator of LA function and may predict the right time for intervention on mitral valve.

Résultats de la dilatation mitrale percutanée chez la femme enceinte à propos de 12 cas

IntroductionMitral stenosis (MS) is the most common valvular heart disease revealed or exacerbated by pregnancy. Percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice when mitral valve morphology is favorable. Aim of the studyThe purpose of this study is to evaluate the immediate, medium and long term results of percutaneous mitral balloon commissurotomy in pregnant women with a severe symptomatic mitral stenosis despite medical treatment. Patients and methodsIt is a retrospective study including 12 pregnant patients diagnosed with severe mitral stenosis and hospitalized in the cardiology department of Habib Thameur hospital between 1994 and 2014. A clinical and ultrasonographic monitoring was performed for over 15 years. ResultsMean patients age was 31.5±4.4 years. All patients were in NYHA class III or IV despite medical treatment. Mitral regurgitation was rated as moderate in four cases. Functional improvement was observed in all cases immediately after the procedure. Mitral valve area increased from 1.02±0.5cm2 averaged to 2±0.35cm2. Mitral regurgitation increased in three cases and appeared in two cases. All patients delivered at term. Newborns were all healthy. Two of them had a low birth weight. On the long term follow-up (95.58±64.1 months), five patients had mitral restenosis: two had a surgical valve replacement and three underwent a second percutaneous mitral balloon commissurotomy. ConclusionThe effectiveness of the percutaneous mitral balloon commissurotomy is clearly documented by clinical and echocardiographic evaluation. In the case of pregnancy, the goal is not so much to obtain an optimal result but to cause hemodynamic improvement authorizing the continuation of pregnancy and childbirth.

TCT-628 Very Long-Term (Up To 23 Years) Follow-Up After Successful Mitral Balloon Valvuloplasty In A Large Series Of Patients With Rheumatic Mitral Stenosis

Introduction: Although there has been a steady decline in the incidence of rheumatic heart disease, rheumatic mitral stenosis still causes significant morbi-mortality worldwide. Percutaneous mitral balloon valvuloplasty (PMBV) remains as the preferred treatment option for patients with suitable anatomy and severe symptomatic rheumatic mitral stenosis. Hypothesis: We sought to assess the very long-term outcomes after successful PMBV. Methods: This is a single center analysis of all consecutive patients who underwent successful PBMV (post-procedural valve area ≥ 1.5 cm 2 and regurgitation moderate or less, without in-hospital major adverse cardiac and cerebrovascular events) between 1988 and 2011. The primary endpoint was to determine the incidence of major adverse cardiac events (MACE), including global death and need for mitral surgery or repeat PMBV up to 23 year after the procedure. Results: Among all 1577 patients, the success rate was achieved in 91.3% (1140 patients). The predictors of success were NYHA functional class III-IV (hazard ratio [HR]: 1.73, 95% CI: 1.15-2.60, p=0.008) and Wilkins-score Conclusions: Up to 23 years after successful PMBV, a sizeable proportion of patients still exhibit sustained results after PMBV.

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

Accura balloon tamponade to successfully treat right common iliac vein perforation — an unconventional use

Percutaneous mitral valvotomy is effective alternative for management of patients with symptomatic mitral stenosis in pregnant women. Gravid uterus may compress and distort inferior vena cava. Patients will have their abdomen shielded with lead sheets to limit fetal radiation exposure. We report a case of six month pregnant women with critical mitral stenosis suitable for PMV. During introduction of Mullins sheath into innominate vein, little resistance was encountered. We could not exactly ascertain the cause as abdomen shielded was there. Mullins sheath was reintroduced and procedure was completed. At the end sudden hypotension was detected with patient complaining of right hip pain. Venogram showed contrast extravasations from the right common iliac vein confirming iliac vein disruption. Accura balloon was placed across the perforated segment and inflated twice for 4 mints, sealing the perforation. This case shows that immediate treatment with balloon tamponade can result in a successful outcome.

PS282 Immediate Echocardiographic and Hemodynamic Outcome of Percutaneous Transvenous Mitral Commissurotomy in Elderly Bangladeshi Severe Symptomatic Mitral Stenosis Patients

PS282 Immediate Echocardiographic and Hemodynamic Outcome of Percutaneous Transvenous Mitral Commissurotomy in Elderly Bangladeshi Severe Symptomatic Mitral Stenosis Patients

Percutaneous Trans-Mitral Commissurotomy in the Contemporary Era, Real Time Experience and a Retrospective Analysis

Rheumatic mitral stenosis is a rare disease nowadays. In the Kingdom of Saudi Arabia and at King Abdulaziz University Hospital, we still see annually a few cases of advanced cases of rheumatic mitral stenosis among adult patients requiring hospital admission and urgent interventional treatment. We opt to study retrospectively the clinical presentation, techniques, outcomes, complications, and predictors of mortality related to percutaneous balloon intervention in patients with symptomatic mitral stenosis who were treated at King Abdulaziz University Hospital between 2009 and 2015. Among 6536 adult admissions over a 6-year time period, there were 21 new cases of symptomatic, echo-confirmed mitral stenosis (3/1000); only 6 cases (28.6%) were eligible for intervention. In the intervention group the mean age was 38; 83% were female; 50% Non-Saudi. In five (83%) out of six cases balloon valvuloplasty had increased mitral valve area by 0.596 ± 0.312 and reduced the mean mitral valve gradient by 6 ± 3.847 (p = 0.05 and 0.012, respectively). The most important predictor of successful dilation to valve area above 1.5 was Wilkin's score. Two indirect deaths occurred in a 6-month follow-up period and were correlated to age of 45 and above with initial presentation of either stroke, or pulmonary hypertension (mean pulmonary artery pressure &gt; 45) and refractory heart failure.

Transjugular balloon mitral valvotomy in a patient with severe kyphoscoliosis

Balloon mitral valvotomy (BMV) performed by the conventional transfemoral approach can be difficult or even impossible in the presence of structural impediments such as severe kyphoscoliosis, gross cardiac anatomic distortion and inferior vena caval anomalies. A 25-year-old woman with severe thoracolumbar kyphoscoliosis due to poliomyelitis presented with symptomatic rheumatic mitral valve stenosis. After the failure of transfemoral BMV, the procedure was attempted from the right jugular access, using a modified septal puncture technique. The left atrium was entered from the jugular access and the mitral valve was crossed and dilated successfully using over the wire balloon technique. Transjugular BMV is an effective alternative in patients with kyphoscoliotic spine that preclude transfemoral approach. The detailed technique used for the procedure, its advantages as well as the other percutaneous treatment options are also discussed.

Immediate Outcome of Percutaneous Balloon Mitral Valvotomy in Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Background and Aim: Percutaneous balloon mitral valvotomy is well established as safe and effective procedure for patients with mitral stenosis due to Rheumatic Heart Disease. There are some retrospective studies on safety and efficacy of it in different subgroups of patients from our centre. Our study aims to assess the safety, efficacy and outcome of it in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Methods: A Single centre, prospective study was conducted from July 1st 2013 to June 31st 2014 in our centre. All the patients who underwent percutaneous balloon mitral valvotomy for moderate to severe mitral stenosis during the study period were included. Safety and efficacy of the procedure was analyzed. Results: There were 262 patients enrolled in the study among which 194 (74%) were females. Mean age of patients was 33.2±12.5 years. Seventy patients (26.7%) were in atrial fibrillation, six (2%) were pregnant, three (1%) had history of stroke, twelve (4.6%) underwent previous surgical or balloon commissurotomy. The mean left atrial pressure reduced from 26.8 ± 8.9 mmHg to 15.6 ± 7.2 mmHg (p &lt; 0.05).The mean mitral valve area increased from 0.9 ± 0.17 cm2 to 1.6 ± 0.28 cm2 (p &lt; 0.05). Forty nine patients (18.7%) developed moderate to severe mitral regurgitation. There was no mortality related to the procedure. The procedural success was achieved in 84% patients. Conclusion: Our study suggests that percutaneous balloon mitral valvotomy is a safe and effective procedure for symptomatic mitral stenosis patients.DOI: http://dx.doi.org/10.3126/njh.v12i1.12325 Nepalese Heart Journal Vol.12(1) 2015: 11-14

0520: Percutaneous mitral commissurotomy in patients over 50 years old: immediate and long-term results

Describe the immediate and final outcome of percutaneous mitral balloon commissurotomy (PMC) with Inoue balloon in patients over 50 years old and associate complications with age and Wilkins score. A retrospective and analytic study was performed with a data base of 480 patients. We included all the patients proceeding in our department from January 1998 to December 2012. 75 were > or = 50-years old (group1). Immediate and late outcomes in this group (group 1) were compared with those in the patients aged < 50-years (group 2). Baseline hemodynamic parameters were comparable in the two groups. The Wilkins score was> 8 in 11 patients We found a Mitral Valvular Area (MVA) before the PMC proceeding of 0.99cm 2 ±0.2 and 1.87cm 2 ±0.38 post PMC (P < 0.001), with pre procedure transmitral gradient of 12.7±4.05 mm Hg and of 4.4±2.3 mm Hg post (P < 0.001). Similar significant improvements were seen in group 2. In 72 patients (96%) the immediate proceeding was considered successful.The hemodynamic result was good in 85.3% of group 1 patients. Tamponade occurred in one patient. Mitral regurgitation grade I or II developed in 8 patients and remained stable in 19 patients. These complication rates were comparable to those seen in group 2. A clinical and echocardiographic follow-up was performed in 68 patients (93%). In the group 1, a good result was maintained in 60% of patients after 75.8±40 months of follow-up. Although restenosis was observed in 28% of patients, functional amelioration was obtained in most of cases. Survival free of mitral valve intervention or heart failure ≥ NYHA III was significantly better for patients with good immediate result. PMC is safe and efficacious in elderly patients with symptomatic mitral stenosis. Long-term results are good and related mainly to the quality of the procedure.

0359: Percutaneous balloon mitral commissurotomy in children and young adults with rheumatic mitral stenosis

To determine the efficacy and the safety of percutaneous balloonmitral commissurotomy (PBMC) in young patients (aged under 18 years – olds) with rheumatic mitral stenosis and to compare these results with those of adult patients. Percutaneous transvenous mitral commissurotomy (PTMC) using the Inoue technique was performed in 480 patients with rheumatic mitral stenosisbetween 1998 and 2013. 41 were aged under 18 years – old (group 1). The other 439 patients (group 2) had a mean age of 34±11.9 years. All patients were assessed clinically. An echocardiography was performed before and after the procedure. Mean age in group 1 was 15±2.95 years (range 8 to 18) with a women predominance (73.2% vs. 26.8%.). In group 1, there was a significant increase of the mean mitral valve area index (MVAI) (0.84±0.24 vs 1.78±0.39cm 2 , p <0.001), a significant reduction of the mean transmitral pressure gradient (21.78±6.62to8.75±5.87 mm Hg, p <0.001) and of the mean left atrial pressure (28.46±7.59to12.87±5.57 mmHg, p < 0,001) from pre- to post-PBMC, respectively. Mild mitral regurgitation developed in 12 and moderate mitral regurgitation developed in 3 patients.The mean follow-up was 92±40 months. Improvement in symptomatic status by at least one NYHA class was seen in the majority of patients.A good result during the follow up was observed in 46.3% of controlled patients and restenosis in 53.7% of cases with an average of 46±34 months. The immediate hemodynamic results in children were compared to 439 adult patients who underwent PBMC in the same period. The outcome was similar in both groups. Children were found to have significantly higher rate of mitral restenosis compared to adults (53.7% vs. 31.9%). Despite a high rate of restenosis, PBMC is very effective and safe in children, and consider that it should be the procedure of choice for young patients with symptomatic rheumatic mitral stenosis.

The Immediate and Short Term Impact of Successful Percutaneous Transvenous Mitral Commissurotomy on Right Ventricular Function

Objectives: The purpose of this study was to evaluate the immediate and short term follow up impact of Percutaneous Transvenous Mitral Commissurotomy (PTMC) on Right Ventricular (RV) function using twodimensional and tissue Doppler echocardiographic indices. Background: In patients with Mitral Stenosis (MS) RV function may be affected due to myocardial and hemodynamic factors. Previous studies using echocardiography have shown discordant results as regards to improvement of RV function immediately after PTMC. Only few studies have evaluated RV function at 6 months follow up. Methods: A total of 90 patients with severe symptomatic MS, all in sinus rhythm, who got admitted for PTMC to author’s institute, were prospectively enrolled. RV function was evaluated by conventional and Tissue Doppler Imaging (TDI) echocardiography before, 48 hours after PTMC, and at 6 months follow up. Results: All patients underwent successful PTMC. The mitral valve area was significantly increased (0.80 ± 0.13 cm2 versus 1.73 ± 0.14 cm2, p=0.0001) immediately after PTMC, while the mean transmitral gradient (21.6 ± 8.0 mm Hg versus 5.9 ± 1.6 mm Hg, p < 0.0001) and systolic pulmonary artery pressure (52.3 ± 23.4 mm Hg versus 41.7 ± 16.9 mm Hg, p < 0.0001) were significantly decreased. There was significant improvement in RV function immediately after PTMC (RV outflow tract fractional shortening (RVOTfs): 54.1 ± 8.7% versus 70.4 ± 5.0%, p < 0.001, Tricuspid Annular Plane Systolic Excursion (TAPSE): 16.0 ± 1.5 mm versus 18.6 ± 1.7 mm, p < 0.0001, TEI INDEX: 0.51 ± 0.04 to 0.34 ± 0.04, p < 0.001). Myocardial velocities measured at lateral tricuspid annulus were not improved significantly immediately after PTMC but improved significantly at 6 months follow up (Myocardial velocity during isovolumic contraction (IVCv); 10.2 ± 0.6 cm/s to 12.0 ± 1.3 cm/s, p < 0.001, systolic myocardial velocity (Sv): 11.7 ± 0.9 cm/s to 13.2 ± 0.9 cm/s , p < 0.001 , myocardial acceleration during isovolumic contraction(IVA): 3.0 ± 0.5 cm/s2 to 3.9 ± 0.3 cm/s2 , p < 0.001). Conclusion: Immediately after successful PTMC, significant improvement in RV function was observed. TDI myocardial velocities and IVA showed gradual improvement in RV function at 6 months follow up. Prognostic value and clinical significance of this improvement deserve further investigation.

Abstract 19824: Percutaneous Mitral Balloon Comissurotomy versus Surgical Comissurotomy in the Treatment of Severe Symptomatic Mitral Stenosis

Introduction: Percutaneous mitral balloon comissurotomy (PMBC) and surgical comissurotomy can be used for treatment of stage D mitral stenosis. Randomized controlled trials (RCTs) comparing PMBC and surgery have shown inconsistent results. Hypothesis: PMBC is associated with better hemodynamic and clinical results for the treatment of stage D mitral stenosis. Methods: Databases were searched for RCTs that compared double-balloon PMBC to surgical comissurotomy. Inclusion criteria were no left atrial clot, a favorable valve morphology and absence of significant mitral regurgitation. Clinical and hemodynamic outcomes were evaluated within short-term (less than 6 months) and long-term (over 6 months) follow up. Random-effects model was used due to anticipated heterogeneity. Results: A total of 6 RCTs with 474 patients were included, of whom 222 (46.8%) underwent PBMC. In short-term follow up, PMBC was associated with a larger mitral valve area (MVA) compared to surgical comissurotomy (mean difference 0.41 cm2; 95% CI 0.16-0.67; p=0.002; figure 1A), but also a higher incidence of moderate to severe mitral regurgitation (MR; OR 2.63; 95% CI 1.04-6.70; p=0.04; figure 1B). Short-term symptomatic (NYHA II-IV) heart failure (p=0.40) and new MR (p=0.32), as well as long-term MVA (p=0.23), restenosis (p=0.39), symptomatic heart failure (p=0.11), new MR (p=0.64) and need for reintervention (p=0.21) were not significantly different between groups. Conclusions: Our meta-analysis of RCTs suggests that PMBC is associated with an increased MVA as well as a higher incidence of moderate to severe MR when compared to surgery in the treatment of stage D MS. Therefore, the decision to proceed with PMBC or surgery in patients suitable for both procedures must rely on patient preferences, physician experience and risk of procedure-specific complications, such as left-to-right shunt with PMBC and wound infection/dehiscence with surgical comissurotomy.

Comparative study of Ivabradine versus atenolol in symptomatic mitral stenosis patients

Comparative study of Ivabradine versus atenolol in symptomatic mitral stenosis patients

Long term results of mitral balloon valvuloplasty

Mitral balloon valvuloplasty (MBV) is the therapy of choice for the treatment of symptomatic mitral stenosis with suitable anatomy. Although its short and mid-term results are favorable, there is a paucity of information about long-term follow-up. To assess the late results of MBV. A cohort of 225 patients aged 8 to 20 years who were subjected to a MBV from 1989 to 2001, was studied. All variables at the time of the procedure, short and long-term results and major events during follow-up (new mitral intervention and mortality) were recorded. Uni and multivariate analysis were used to assess prognosis. The mean follow-up lapse was 13.5 years (range 8 to 20 years). During this period, 88 patients (39.1%) remained event-free and in acceptable functional capacity. Eight percent died, 8% required a second MBV and 43.5% required a surgical mitral valve replacement. A post-procedural area equal or greater to 1.9 cm² was associated with a greater likelihood of free-event survival (log rank test: p = 0.02/Cox proportional regression model: coefficient 0.54, p = 0.04). MBV is effective, although there is a high chance of new interventions in the long-term follow-up. A larger post-procedure mitral area is associated with a better prognosis.

Pregnancy complicated by valvular heart disease: an update.

Cardiovascular disease complicates ≈1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. Although its prevalence is considered relatively low in pregnant women, heart disease is the most common cause of maternal mortality. Because more women with congenital or

Effect of Increased Severity of Mitral Regurgitation and Preprocedural Right Ventricular Systolic Dysfunction on Biventricular and Left Atrial Mechanical Functions Following Percutaneous Mitral Balloon Valvuloplasty

Severe mitral stenosis (MS) may impair left atrial (LA) pump function, and increase LA and pulmonary venous pressure resulting in right ventricular (RV) systolic dysfunction. The aim of this study was to evaluate biventricular and LA function after percutaneous mitral balloon valvuloplasty (PMBV) by tissue Doppler (TDI) and speckle tracking echocardiography (STE). Twenty-eight consecutive patients with severe symptomatic rheumatic MS (11 men, mean age: 39 ± 7 years) who were referred for PMBV were included in the study. In addition to conventional echocardiography, all patients underwent TDI and two-dimensional (2D) (STE) to assess left ventricular (LV), LA, and RV function before and 3 months after PMBV. Severity of mitral regurgitation (MR) was graded by the ratio of MR jet area to LA area (JA/LAA) method and any postprocedural progression of the JA/LAA ratio was defined as worsening of MR. Peak systolic velocity of tricuspid lateral annulus (RVs) <11.5 cm/sec was accepted as RV dysfunction. Left atrial diameter and area were decreased, while LV dimensions were unchanged following the valvuloplasty. PMBV improved STE-based LV mechanical indices, LA reservoir and conduit function, and RV free wall basal longitudinal strain (LS) and displacement. Increased severity of MR was detected in 6 patients, and PMBV did not improve the STE-based RV or LV function in these patients, while LA reservoir and conduit function were both improved independent of MR worsening. There was significant improvement in RVs and RV basal LS in the 15 patients with preprocedural RV systolic dysfunction, while the improvement in patients with normal preprocedural RV function was not significant. Percutaneous mitral balloon valvuloplasty may improve both LA and biventricular function in patients with severe symptomatic MS. Both TDI and STE are useful to determine biventricular and LA function after PMBV. Although the number of patients was insufficient, worsening of MR after PMBV may limit the improvement in RV and LV function, while preprocedural RV dysfunction does not seem to limit the improvement in RV function and pulmonary artery systolic pressure. Large scale follow-up studies are required to see whether the changes observed in cardiac mechanics are persistent.

Emergent balloon mitral valvotomy in pregnant women presenting with refractory pulmonary edema

Mitral stenosis is the most common valvular heart lesion found in pregnancy. When severe, it leads to significant risk of mortality for both mother and fetus, since the hemodynamic adaptations to pregnancy are badly tolerated. Many pregnant women with mitral stenosis present in a critically ill condition. The role of balloon mitral valvotomy (BMV) in such patients is ill-defined. We sought to evaluate the feasibility, efficacy and safety of emergent BMV in pregnant patients with refractory pulmonary edema and to determine maternal and fetal outcome. Of 88 patients undergoing BMV during pregnancy from January 1990 to December 2011 in Cardiology A Department of Monastir Hospital, 28 women were in New York Heart Association functional class IV and underwent emergent BMV. During the procedure, radiation exposure was minimized by means of total abdominal and pelvic shielding. The mothers’s mean age at the time of BMV was 28.86 ± 5.7 (range 19–43) years, and the gestation period was 30 ± 5.1 (range 20 –39) weeks. Ten patients were primiparas. Mitral valve (MV) was assessed using the Wilkins score which averaged 7.4 ± 1.8 (range 4–14). Fluoroscopy time was 7.8 ± 1.9 min. The BMV procedure was successful in 25 (89.3%) patients with a dramatic improvement in patient symptoms. The mitral valve area increased from 0.8 ± 0.2 cm2 to 2.2 ± 0.42 cm2 (p < 0.0001). The mitral valve pressure gradient decreased from 22.2 ± 9.3 to 5.7 ± 4 mmHg (p < 0.0001). The left atrial pressure decreased from 29.4 ± 9.3 to 15.4 ± 7.3 mmHg (p < 0.0001). The pulmonary artery pressure decreased from 58.8 ± 21.1 to 37.2 ± 14.3 mmHg (p < 0.0001). One patient developed severe mitral regurgitation and required urgent mitral valve replacement. There was no maternal mortality or significant foetal morbidity. Pregnancy was uneventful in all patients, all babies were born at full term by spontaneous vaginal delivery in 24 cases (85.7%) and by cesarian section for obstetrical reasons in 4 (14.3%), with no obvious malformations (4 of them were twin babies). None of the babies needed intensive care monitoring. The average Apgar scores at 1 min were 8.6 ± 1. The mean birth weight was 3.1 Kilograms (Kg) ranged from 1.9 to 3.8 kg. During pregnancy, emergent BMV is safe and feasible in patients with symptomatic mitral stenosis and severe pulmonary edema. There is marked symptomatic relief, along with excellent maternal and fetal outcomes.

Mitral balloon valvotomy in pregnant women: Long-term follow-up

The study aim was to examine the long-term outcome (nine years) of mitral balloon valvotomy in pregnant patients with severe mitral stenosis. Twenty-three patients with severe, symptomatic (NYHA class III/IV) mitral stenosis underwent material balloon valvotomy using an lnoue balloon technique during the second trimester of their pregnancy; mean follow up was 5.1 ± 2.8 year (range: 1–9 years). The procedure was successful in all patients. Immediately after valvotomy, the Doppler-derived mitral valve area increased from 0.90 ± 0.18 to 1.97 ± 0.36 cm2 (p < 0.0001), and the transmitral mean gradient decreased from ‘15.7 ± 4.7 to 5.5 ± 1.6 mmHg (p < 0.0001). Four patients had mild worsening of mitral regurgitation, and six developed insignificant interatrial communication immediately after valvotomy. There was no other morbidity or mortality. Patients showed a significant improvement in mean NYHA class Twenty-two patients had normal deliveries; one cesarean section in week 36 resulted in stillbirth. No developmental abnormalities were seen in the babies. At long-term follow up of mothers, the mitral valve area was 1.8 ± 0.52 cm2, restenosis developed in three patient (16%). One baby died at one week from sudden infant death syndrome, one at eight months from pneumonia. All other children showed normal growth, development and speech for their age. Mitral balloon valvotomy using the Inoue balloon technique can provide satisfactory immediate and long-term outcome in pregnant patients with severe mitral stenosis.