Percutaneous mitral commissurotomy in pregnant women: Immediate and long-term outcomes

Authors

  • Selim Boudiche Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Abdeljalil Farhati Cardiology Department, La Rabta Hospital, Tunis, Tunisia
  • Sofien Haboubi Cardiology Department, Mongi Slim Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Manel Abbassi Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
  • Mohamed Chedly Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
  • Faten El Ayech Boudiche Cardiology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Zeynab Jebbari Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Amal Ben Salem Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Khaled Ezzaouia Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Boutheina Besbes Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Foued Daly Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Rim Ben Rejeb Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Dhekra Sebki Anesthesiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Ines Bounaoues Department of Anesthesiology, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Mehrez Gouader University of Tunis El Manar, Faculty of Medicine of Tunis, Anesthesiology Department, La Rabta Hospital, 1007, Tunis, Tunisia
  • Fathia Mghaieth Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Sana Ouali Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Noureddine Larbi Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Manel Ben Halima Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
  • Mohamed Sami Mourali Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

DOI:

https://doi.org/10.62438/tunismed.v104i01.6450

Keywords:

Mitral stenosis, Pregnancy, Mitral valvuloplasty

Abstract

Background: Rheumatic mitral stenosis (MS) is prevalent in developing countries. Poorly tolerated during pregnancy, MS is often requiring urgent intervention.

Objectives: This study aimed to evaluate immediate and long-term outcomes after percutaneous (PMC) in pregnant women.

Methods: Observational retrospective study of pregnant women who underwent PMC for severe MS between January 2008 and December 2018. Primary endpoint was procedural success (mitral valve area > 1.5 cm²) without complications.

Results: 39 patients. Mean age 34.2±5.1 years. Mean gestational age 28.2±4.9 weeks. PMC was successful in 37 patients (94.8%). There was no maternal mortality. Two procedures failed (1 transseptal puncture failure and 1 severe traumatic mitral regurgitation requiring emergent surgery). If successful, PMC allowed the pursue of pregnancy until full term and vaginal delivery in 36 (92.3%) and 20 (51.3%) patients, respectively. One in utero foetal demise and one neonatal death occurred. At 56.1-month, after exclusion of three patients with prompt surgical valve replacement, there were 7 cases of mitral restenosis (19.4%) with Wilkins score >8, suboptimal result (valve area between 1.5 and 1.8 cm²) and incomplete bicommissural splitting as predictive factors. All babies maintained normal growth and development.

Conclusion: This study confirmed effectiveness and safety of PMC during pregnancy when performed by an experienced team with a procedural success of 94.8% but at the cost of a restenosis rate of 19.4% at 56.1 months. These were predicted, in addition to Wilkins score, by a suboptimal but accepted immediate result of the procedure, still allowing a step forward.

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