TREATMENT OF SEVERE MITRAL-STENOSIS WITH PERCUTANEOUS BALLOON VALVOTOMY IN PREGNANT PATIENTS

Background: Pregnancy can cause life-threatening complications in wome n with mitral stenosis. Frequently, there is an urgent need to increas e the mitral valve area mechanically. In selected cases, percutaneous mitral balloon valvotomy (PMBV) has emerged as a safe and effective al ternative to surgical commissurotomy. Hypothesis: The study evaluates the effects of PMBV by the Inoue technique in nine pregnant patients w ith severe symptomatic mitral stenosis. Methods: The patients were in New York Heart Association (NYHA) functional class II to IV and had ec hocardiographic scores of less than or equal to 8. The mean gestationa l age was 24.8 +/- 6.1 weeks. The patient's pelvic and abdominal regio ns were covered with a lead apron to protect the fetus from radiation. A stepwise dilatation technique was used. Fluoroscopy time was kept t o 10 to 15 min. Results: One patient developed severe mitral regurgita tion requiring emergency valve replacement. The remaining eight patien ts showed marked immediate symptomatic and hemodynamic improvement. Af ter dilatation, the transmitral pressure gradient decreased from 20.8 +/- 6.5 to 7.3 +/- 1.4 mmHg (p = 0.001) and the calculated mitral valv e area increased from 0.9 +/- 0.1 to 1.8 +/- 0.4 (p < 0.001). All pati ents had uneventful term deliveries of normal babies. On follow-up the y were in NYHA functional class I. Conclusions: Percutaneous mitral ba lloon valvotomy is a safe and effective procedure for selected pregnan t patients with severe mitral stenosis. The procedure is well tolerate d by the fetus. Severe mitral regurgitation requiring immediate surger y may occur occasionally. The possible harmful effects to the fetus fr om its exposure to radiation during PMBV are unknown.