Percutaneous Transvenous Mitral commissurectomy in Pregnancy patients and its Outcome.

Dr G.Selvarani; Dr A.B.Rajasekar; Dr.S.Balasubramanian; Dr S.R.Veeramani; Dr G.S.Sivakumar; Dr.S.Sathishkumar; Dr.R.R.Saravanan; Dr R.Ramesh; Dr.T.R.Hemanath; Dr.G.Nagasundar; Dr M.Saravanan

Volume : IX, Issue : IV, April - 2019

Percutaneous Transvenous Mitral commissurectomy in Pregnancy patients and its Outcome.

Dr G. Selvarani, Dr A. B. Rajasekar, Dr. S. Balasubramanian, Dr S. R. Veeramani, Dr G. S. Sivakumar, Dr. S. Sathishkumar, Dr. R. R. Saravanan, Dr R. Ramesh, Dr. T. R. Hemanath, Dr. G. Nagasundar, Dr M. Saravanan

Abstract :

Background: Rheumatic mitral stenosis constitutes a major cause of acquired heart disease complicating pregnancy in India.1 Symptomatic worsening occurs during pregnancy because of increased hemodynamic burden associated with pregnancy, which includes increased blood volume, heart rate, mean left atrial pressure, and pulmonary venous pressure which can precipitate pulmonary edema.2–5 Medical treatment alone may not be sufficient in these patients and relief of mitral obstruction is often required. Treating these patients with surgical valvotomy has shown to have adverse fetal outcomes. Balloon mitral valvotomy (BMV)/ Percutaneous Transvenous Mitral commissurectomy(PTMC) procedure is an alternative option in this situation. In the present study, we have examined the fetal and maternal outcomes of women undergoing PTMC during pregnancy. Methods and Results: It is a prospective,Observational followup study. We studied admitted Pregnant patients with Rheumatic severe valvular mitral stenosis underwent Percutaneous Transvenous Mitral commissurectomy procedure in our hospital from August 2016 to Feuary 2019. 15 pregnant women were included in this study in whom balloon mitral valvotomy was performed. The mean age of these patients was 26.7 ± 3.1 years. The mean gestational age was 26.5 ± 5.2 weeks (12–36 weeks). The procedure was successful in 15 patients (100%). Mean two–dimensional MVA increased from baseline value of 0.77 ± 0.17 cm2 to 1.77 ± 0.27 cm2 (p value <0.04). Pre–procedure peak pulmonary artery pressure was 36.05 ± 16.88 mmHg, which decreased to 10.31 ± 2.36 mmHg (pvalue <0.0001). Hemodynamic data showed pre–BMV left atrial mean pressure of 25.2 ± 6.6 mmHg, which decreased to 10.3 ± 4.8 mmHg after the procedure (p value <0.04). The Mean left atrial pressure decreased on average by 42%, and the maximum pressure (V wave) decreased on average by 40%. Mean fluoroscopy time was 9.0 ± 1.2 min. There was no maternal mortality in our study.No cardiac tamponade ,cardiac perforation ,severe mitral regurgitation noted in this study. Post–procedure follow–up showed an improvement in NYHA status by at least one class in 100% of patients. Nine (71.4%) patients had a term normal vaginal delivery and 4 (28.5%) underwent cesarean section for obstetric indications at 38 weeks of gestation. One of the patients hadIUD with spontaneous expulsion one month after procedure. All patients were discharged 24 to 48 h after valvuloplasty, continuing their pregnancies without complications. All without complications with healthy newborns that developed normally. In follow–up, no patient who had moderate/Severe mitral regurgitation after valvuloplasty and not requiring surgical correction after the PTMC Procedure.