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 cm(2) (range 0.5-1.0 cm(2)) to 2.2 +/- 0.12 cm(2) (range 1.9-2.6 cm(2)) (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). All patients were in New York Heart Association functional class I. No patient has shown any evidence of restenosis. The mitral valve area on follow-up was 2.1 +/- 0.21 cm(2). The degree of mitral regurgitation remained unchanged. The results of this study indicate that percutaneous mitral commissurotomy is a safe and effective procedure for severe mitral stenosis in pregnancy. There are no immediate detrimental effects of radiation on the fetus, though long-term effects of this amount of radiation are yet to be ascertained. (c) 1994 Wiley-Liss, Inc.