Managing Pregnancy in the Presence of Rheumatic Heart Disease and Antiphospholipid Syndrome

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe rheumatic mitral stenosis and antiphospholipid syndrome in pregnancy (n=1). Intervention: Percutaneous transvenous mitral commissurotomy (PTMC) and multidisciplinary medical management (metoprolol, furosemide, low-molecular-weight heparin, warfarin, aspirin, penicillin G). Primary outcome: Mitral valve area and maternal/fetal pregnancy outcome.

Q: What does this research mean for the field?

In pregnant patients with coexisting severe rheumatic mitral stenosis and antiphospholipid syndrome, timely percutaneous transvenous mitral commissurotomy and multidisciplinary care improve hemodynamics and enable uncomplicated term delivery. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

S. Zahid; Mannal Ahmed; Reema Qayoom; Hannah Asghar

doi:10.1016/j.jaccas.2025.106399

January 14, 2026JACC Case ReportsOpen Access

Managing Pregnancy in the Presence of Rheumatic Heart Disease and Antiphospholipid Syndrome

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Key result

PTMC relieves severe mitral stenosis to enable uncomplicated term delivery in pregnancy.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Coexistence of severe mitral stenosis and antiphospholipid syndrome during pregnancy presents an exceptionally high-risk clinical scenario requiring multidisciplinary management.

Does percutaneous transvenous mitral commissurotomy combined with multidisciplinary medical and anticoagulation therapy improve hemodynamic parameters and enable favorable maternal and fetal outcomes in a pregnant woman with severe rheumatic mitral stenosis and antiphospholipid syndrome?

Key Points

To describe the multidisciplinary clinical management of a high-risk pregnancy complicated by coexisting severe rheumatic mitral stenosis and antiphospholipid syndrome.
Clinical evaluation and management of a 31-year-old multigravida patient (G8P0A7) presenting at 20 weeks of gestation with NYHA functional class III dyspnea, persistent cardiolipin IgG >40 GPL units, and severe mitral stenosis.
Multimodal risk stratification using mWHO (class IV), CARPREG (score of 3; predicted 6.5% cardiac risk), and ZAHARA (score of 2.25; predicted 7.5% event risk) frameworks.
Therapeutic protocol comprising medical stabilization with metoprolol and furosemide followed by percutaneous transvenous mitral commissurotomy.
Baseline echocardiography revealed severe mitral stenosis with a valve area of 0.8 to 0.9 cm², peak transmitral gradient of 30.4 mm Hg, and mean gradient of 20.7 mm Hg.
The patient successfully underwent percutaneous transvenous mitral commissurotomy and delivered a healthy infant at term without complications.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does percutaneous transvenous mitral commissurotomy combined with multidisciplinary medical and anticoagulation therapy improve hemodynamic parameters and enable favorable maternal and fetal outcomes in a pregnant woman with severe rheumatic mitral stenosis and antiphospholipid syndrome?

P

Population

1 pregnant woman (age 31, G8P0A7 at 20 weeks gestation) in Pakistan with severe rheumatic mitral stenosis (NYHA class III, mWHO class IV) and antiphospholipid syndrome, followed for 1.5 years postnatally.

I

Intervention

Percutaneous transvenous mitral commissurotomy (PTMC) via femoral access under sedation and local anesthesia guided by fluoroscopy and transesophageal echocardiography, combined with medical therapy including metoprolol, furosemide, penicillin G, aspirin, low-molecular-weight heparin (first trimester), and warfarin (from 13 to 36 weeks of gestation, target INR 2-3).

O

Outcome

Maternal and fetal survival and clinical outcomes at term delivery and over 1.5 years of postnatal follow-up, alongside postprocedural hemodynamic improvement in mitral valve area and transmitral pressure gradients.hard clinical

Implication

This case report demonstrates that timely percutaneous transvenous mitral commissurotomy combined with tailored anticoagulation and multidisciplinary cardio-obstetric care can achieve successful maternal and fetal outcomes in a pregnant woman with both severe rheumatic mitral stenosis and antiphospholipid syndrome.

Abstract

BACKGROUND: Rheumatic heart disease remains a major cause of maternal morbidity and mortality in low- and middle-income countries. The coexistence of severe mitral stenosis (MS) and antiphospholipid syndrome presents an exceptionally high-risk clinical scenario requiring multidisciplinary management. CASE SUMMARY: , and she delivered a healthy baby at term without complications. DISCUSSION: Pregnancy in women with rheumatic MS and antiphospholipid syndrome demands coordinated care to balance hemodynamic and thrombotic risks while ensuring fetal safety. TAKE-HOME MESSAGE: Timely cardiac intervention, multidisciplinary collaboration, and individualized care enable favorable maternal and fetal outcomes in complex high-risk pregnancies.

Discussion

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Cite This Study

Zahid et al. (2026) conducted a case report in Severe rheumatic mitral stenosis and antiphospholipid syndrome in pregnancy (n=1). Percutaneous transvenous mitral commissurotomy (PTMC) and multidisciplinary medical management (metoprolol, furosemide, low-molecular-weight heparin, warfarin, aspirin, penicillin G) was evaluated on Mitral valve area and maternal/fetal pregnancy outcome.

synapsesocial.com/papers/6a777c94249abce98a1e70ac https://doi.org/10.1016/j.jaccas.2025.106399

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Managing Pregnancy in the Presence of Rheumatic Heart Disease and Antiphospholipid Syndrome

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Managing Pregnancy in the Presence of Rheumatic Heart Disease and Antiphospholipid Syndrome

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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