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Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women With Severe Mitral Stenosis Publisher



Firouzi A1 ; Samiei N2 ; Ahmadi S1 ; Naderi N3 ; Sadeghipour P1 ; Sanati HR1 ; Kashfi F2 ; Sattarzadeh R4 ; Hantoushzadeh S5 ; Bayat M3 ; Pourtaghi S3 ; Nasiri M3
Authors
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Authors Affiliations
  1. 1. Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
  2. 2. Heart valve disease Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran
  4. 4. Echocardiography Laboratory, Department of Cardiovascular Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Maternal Fetal Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Tehran University Heart Center Published:2019


Abstract

Background: Mitral stenosis tends to worsen during pregnancy because of the increase in the cardiac output and the heart rate. In nonresponders to medical therapy, percutaneous transluminal mitral commissurotomy (PTMC) may be performed when there is a suitable valvular anatomy. In this study, we aimed to investigate the clinical and fetal outcomes of pregnant women with mitral stenosis who underwent PTMC. Methods: Thirty-one patients undergoing PTMC during pregnancy were enrolled in this study. The mitral valve area (MVA), the transmitral valve mean gradient (MVMG), and the severity of mitral regurgitation were assessed pre- and postprocedurally by transthoracic and transesophageal echocardiography. The radiation time was measured during the procedure. The patients were followed up during pregnancy, and the neonates were monitored for weight, height, the head circumference, the birth Apgar score, and the adverse effects of radiation for at least 12 months. Results: PTMC was successfully performed on 29 (93.5%) patients. No maternal death or pulmonary edema was reported. The mean MVA significantly increased (from 0.73±0.17 cm2to 1.28±0.24 cm2; P<0.001), and the mean MVMG significantly decreased (from 19.62±5.91 mmHg to 8.90±4.73 mmHg; P<0.001) after the procedure. A significant decrease in the systolic pulmonary artery pressure was also detected. Mitral regurgitation did not increase in severity in 16 (51.6%) patients. There was no significant relationship between the Apgar score, weight, height, and the head circumference at birth and at the radiation time. Conclusion: In our series, PTMC during pregnancy was a safe and effective procedure. Lowering the radiation time with low frame-count techniques confers a significant decrease in radiation-related complications. © 2019, Tehran Heart Center. All Rights Reserved.