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Successful Percutaneous Balloon Mitral Valvuloplasty in Pregnant Woman with Severe Mitral Stenosis

Author : A.P. Mangkoesoebroto, R.A. Raharjo, A. Perdana, 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) is recommended by ESC Guideline for severe MS patients with symptoms or systolic pulmonary artery pressure >50 mmHg. PBMV on pregnant woman is a rare procedure that should be performed carefully and meticulously by experienced operator.

Case Presentation: A 27 years old pregnant woman with G1P0A0, 26 weeks of gestation, presented to hospital with shortness of breath since 3 months before admission, which worsened with less than ordinary activity and accompanied with orthopneu, palpitation and swollen leg. Mid-diastolic murmur grade 3 was heard on cardiac apex. ECG showed sinus rhythm with right axis deviation, left atrial enlargement and right ventricular hypertrophy. Chest X ray showed an enlarged left atrium and right ventricle. TEE found Mitral Valve Area (MVA) planimetry of 0.49 cm2, by VTI 0.47 cm2 , by PHT 0.48 cm2, that suggested severe MS ,Willkins score was 6. PBMV was performed with inoue balloon technique and abdominal shielding. After balloon inflation MVG was reduced from 22 mmHg to 5 mmHg, MVA planimetry 1.52 cm2, by VTI  1.05 cm2, by PHT  1.02 cm2. One day after PBMV, patient’s shortness of breath has improved. Patient was discharged on the 4th day of hospitalization.

Discussion: PBMV in pregnant women is preferably performed after 20 weeks of gestation. Abdominal lead shielding is recommended and radiation dose should be minimized. In this context, PBMV is successful in expanding MVA from 0.49 cm2 to 1.52 cm2 and reduce MVG from 22 mmHg to 5 mmHg, in accordance with symptom relief.

Conclusion: PBMV during pregnancy is safe, provides excellent symptomatic relieve and hemodynamic improvement. This should be considered as the treatment of choice in managing pregnant women with severe mitral stenosis.

KEYWORDS : percutaneous balloon mitral valvuloplasty, mitral stenosis, pregnancy

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