Long-term outcome of mitral balloon valvotomy in pregnant women

Background and aim of the study: The study aim was to examine the long-term outcome (nine years) of mitral balloon valvotomy in pregnant patients with severe mitral stenosis. Methods: Twenty-three patients with severe, symptomatic (NYHA class III/IV) mitral stenosis underwent mitral balloon valvotomy using an Inoue balloon technique during the second trimester of their pregnancy; mean follow up in 19 patients was 5.1 +/- 2.8 years (range: 1 to 9 years). Results: The procedure was successful in all patients. Immediately after va lvotomy, 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 decrea sed from 15.7 +/- 4.7 to 5.5 +/- 1.6 mmHg (p <0.0001). Four patients had mi ld worsening of mitral regurgitation, and six developed insignificant inter atrial communication immediately after valvotomy. There was no other morbid ity or mortality. Patients showed a significant improvement in mean NYHA cl ass, from 3.0 +/- 0.1 to 1.0 +/- 0.02 (p <0.001). Twenty-two patients had n ormal deliveries; one cesarean section in week 36 resulted in stillbirth. N o 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 devel oped in three patients (16%). One baby died at one week from sudden infant death syndrome, and one at eight months, from pneumonia. All other children showed normal growth, development and speech for their age. Conclusion: Mitral balloon valvotomy using the Inoue balloon technique can provide satisfactory immediate relief and long-term outcome in pregnant pat ients with severe mitral stenosis.