Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy

OBJECTIVES We sought to compare the maternal and fetal outcomes of patients with severe mitral stenosis submitted to percutaneous balloon dilation Ver sus open mitral valve commissurotomy (MVC) during pregnancy. BACKGROUND Heart failure in patients with mitral stenosis complicating preg nancy is a common problem in developing countries. Since 1984, percutaneous dilation of the mitral valve using a balloon catheter has become a therape utic alternative to open heart surgery. Although the efficacy of percutaneo us mitral valve balloon dilation is well established, its results have neve r before been compared viith the results of commissurotomy during pregnancy . METHODS We compared the clinical and obstetric complications in 45 women wh o were treated with percutaneous mitral valve balloon dilation (group I, n = 21; from 1990 to 1995) or open MVC (group II, n = 24; from 1985 to 1990) for severe heart failure due to mitral stenosis during pregnancy. RESULTS In our study, percutaneous balloon dilation of the mitral. valve ha d a success rate of 95% (Gorlin formula) and 90.5% (echocardiographic "pres sure half-time" method), as demonstrated by the final mitral valve area ach ieved. This improvement was followed by a marked decrease in the mitral val ve gradient, left atrial pressure and mean pulmonary artery pressure. Patie nts in both groups had similar improvements in symptoms. Patients who under went percutaneous balloon dilation had significantly fewer fetal complicati ons, with a reduction in fetal and neonatal mortality (1 death in group I v s. 8 in group II, p = 0.025). CONCLUSIONS Percutaneous balloon mitral valvuloplasty is safe and effective and appears to be preferable for the fetus, compared with open MVC during pregnancy. (J Am Coil Cardiol 2001;37:900-3) (C) 2001 by the American Colle ge of Cardiology.