Percutaneous mitral dilatation in pregnant women: Short-term results

Introduction Rheumatic mitral stenosis (MS) is one of the most common valvulopathies in north Africa. Among her circumstances of discovery,pregnancy. Percutaneous mitral dilatation (PMD) is currently the treatment of choice for tight MS. Purpose To describe the short-term results of PMD performed for pregnant women with tight MS. Patients and methods This is a retrospective study of 8 pregnant women with a tight MS hospitalized in our Cardiology Department between 2012 and 2018 for PMD. For each patient, clinical, echocardiographic(TTE), and hemodynamic data were analyzed before and after PMD. Results There were 8 patients with an average age of 28.5 years (from 25 to 37). Two patients were known to have a MS and had previous PMD. All patients consulted for NYHA stage III dyspnea. At the ECG: 6 were in sinus rhythm. TTE pre-dilatation showed: an average mitral surface area at 1.1 cm2,the average transmitral gradient was on average 12.05 mmHg. There was a bi-commissure fusion of the mitral valve in 6 patients. Mitral insufficiency (MI) was: minimal in 2 cases and moderate in 1 case, 5 patients had pulmonary arterial hypertension with mean SPAP at 43.2 mmHg. The right cavities were dilated in two women. The result of PMD was satisfactory in all patients. MI worsened one grade in one patient, and two grades in another, while a MI was newly created in one case. A transition to atrial fibrillation was noted in 1 patient who was well tolerated. TTE control immediately after PMD in the catheterization room showed: an average mitral area of 1.9 cm2 (1.4 to 2.4 cm2) so an improvement of more than 50% in the initial mitral area. The average transmitral gradient became 4.67 mmHg. Both commissures were completely opened in 7 patients. Dyspnea became class I in one patient while the others became asymptomatic. All patients delivered at term. The newborns were all in good health. Conclusion PMD is still the treatment of choice in pregnant women with symptomatic MS if the anatomy of the valve allows it.