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Percutaneous Balloon Mitral Valvuloplasty in Pregnancy with Severe Mitral Stenosis: Case Series in dr Kariadi General Hospital Semarang

Author : A.P. Mangkoesoebroto, R. A. Raharjo, A. Perdana, M.J. Satyo, S. B. Utami, Y. Herry, S. Rifqi
Upload Date : 19-04-2018

Background: Moderate or severe Mitral Stenosis (MS) is poorly tolerated during pregnancy. Percutaneous Balloon Mitral Valvuloplasty (PBMV) has become a therapeutic of choice in patients with MS. This report described the profiles of pregnant women underwent PBMV.

Methods

This study was a descriptive analysis using data from medical record. The inclusion criteria were pregnant women with severe MS who underwent PBMV in Dr. Kariadi General Hospital Semarang during January 2005 until January 2018. The exclusion criteria were chronic kidney disease, infection, and history of stroke. Serial echocardiography was performed pre- and post-PBMV, evaluating mitral valve area (MVA), mitral valve gradient (MVG), and mean pulmonary artery pressure (mPAP).

Results: The study enrolled 7 patients, with a mean age of 34.28 ± 9.37 years. All of them presented with shortness of breath. The rhythm were atrial fibrillation and sinus in 42.9% and 57.1%, respectively. The echocardiogram prior to PBMV revealed a severe MS (100%) and Wilkin’s score of 6.00±1.00, with other findings of mild mitral regurgitation (42.9%), severe tricuspid regurgitation (42.9%), severe pulmonary hypertension (71.4%), and mild aortic regurgitation (42.9%).They underwent PBMV procedure at 28.00±1.63 weeks of gestation, with abdominal shielding to protect the fetus. MVA improved from 0.65±0.11 cm2 to 1.55±0.22 cm2,MVG reduced from 21.00±0.81 mmHg to 9.28±3.45 mmHg, and mPAP reduced from 59.32±14.83 to 41.27±9.96 soon after procedure, accompanied with symptoms improvement in all patients. These patients kept their pregnancy and delivered at 38.50±0.83 weeks of gestation. All whom delivered, 66.7% had vaginal delivery and 33.3% had caesarean section. Their babies were healthy at discharge and have normal growths and developments until 2 years follow-up.

Conclusion: PBMV in pregnant patients is feasible, safe, and effective by improving MVA, MVG, and mPAP along with symptomatic relief, without any fetomaternal complications.

KEYWORDS : pregnancy, mitral stenosis, percutaneous ballon mitral valvuloplasty, rheumatic heart disease


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