Percutaneous balloon mitral valvuloplasty in pregnant patients with rheumatic mitral stenosis: A ten-year single-center experience

Background Rheumatic mitral Stenosis is a common issue in Tunisia causing significant morbidity and mortality. Women with severe mitral stenosis often do not tolerate cardiovascular demands of pregnancy despite medical therapy, with an urgent need to enhance mitral valve area by percutaneous balloon mitral valvuloplasty (BMV). Purpose To determine immediate and long-term maternal and fœtal outcomes after BMV during pregnancy. Methods This was retrospective single center experience, analysing data from BMV registry from January 2008 to December 2018. Methods and results During the study period, 40 pregnant women among a total of 461 patients (9%) underwent BMV for severe mitral stenosis. The mean age was 35 ± 5 years. The mean gestational age was 26 ± 8 weeks. The BMV was successful in 38 out of 40 patients (95%), achieving mitral area u003e 1.5 cm2 with a drop in left atrial mean pressure from 30 ± 9 mmHg to 16 ± 5 mmHg. In all successful procedures, patients improved their NYHA status by at least one stage. There was no maternal mortality in our series. One procedure had to be abandoned because of failed septal puncture. One patient developed severe mitral regurgitation secondary to chordae rupture, and had as a consequence emergent valve replacement. Thirty-three patients had a normal delivery while seven patients underwent a caesarean section. We reported a single neonatal death 48 hours after delivery caused by preterm respiratory distress. The BMV permitted a clinical and hemodynamic improvement and allowed the pursuit of pregnancy until end of term in most of cases. On 57-month mean follow-up, there were 3 cases of mitral restenosis, all babies maintained normal growth and development. Conclusion Percutaneous balloon mitral valvuloplasty was associated with low maternal and fœtal risk and should be considered as the treatment of choice in pregnant women with severe mitral stenosis.