PERCUTANEOUS MITRAL COMMISSUROTOMY FOR SEVERE MITRAL-STENOSIS DURING PREGNANCY

Percutaneous mitral commissurotomy was performed in 27 pregnant female s aged 24.9 +/- 3.14 years (range 20-30 years) with severe mitral sten osis at 22.2 +/- 4.3 weeks (range 18-32 weeks) of gestation. All patie nts 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. Pe rcutaneous mitral commissurotomy was successful in 26 patients. The mi tral valve area assessed by Doppler echocardiography (pressure half ti me) 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 gradien t 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 gradie nt 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 regurgita tion with anterior mitral leaflet tear needing immediate mitral valve replacement. Twenty-six patients improved to New York Heart Associatio n class I after the procedure. Twenty-four patients had full-term, nor mal delivery and gave birth to healthy infants. The patients were foll owed 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 unchange d. The results of this study indicate that percutaneous mitral commiss urotomy is a safe and effective procedure for severe mitral stenosis i n pregnancy. There are no immediate detrimental effects of radiation o n the fetus, though long-term effects of this amount of radiation are yet to be ascertained. (c) 1994 Wiley-Liss, Inc.