Severe Rheumatic Mitral Stenosis During Pregnancy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe rheumatic mitral stenosis during pregnancy (n=1). Intervention: Medical therapy (metoprolol, intravenous furosemide, oxygen) during pregnancy followed by postpartum percutaneous balloon mitral commissurotomy (PBMC). Primary outcome: Mitral valve area and symptomatic improvement after postpartum percutaneous balloon mitral commissurotomy.

Q: What does this research mean for the field?

Conservative medical management with beta-blockers and diuretics can allow pregnancy to progress to late preterm gestation in severe rheumatic mitral stenosis, enabling percutaneous commissurotomy to be safely deferred until the postpartum period. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Antônio Mutarelli; Alexandre Negrão Pantaleão; MARIA CARMO P. NUNES

doi:10.1016/j.jaccas.2024.102634

October 1, 2024JACC Case ReportsOpen Access

Severe Rheumatic Mitral Stenosis During Pregnancy

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Key result

Postpartum PBMC expands mitral valve area to ~1.60 cm² following conservative antepartum management.

n=1

Figures

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

Key Points

To describe the clinical management and procedural decision-making for a pregnant woman presenting with severe, previously undiagnosed rheumatic mitral stenosis.
A 28-year-old woman (gravida 2 para 1) at 26 weeks of gestation underwent clinical evaluation and three-dimensional transthoracic echocardiography for progressive dyspnea.
Conservative medical therapy comprising metoprolol, intravenous furosemide, and supplemental oxygen was initiated to defer percutaneous intervention.
Multidisciplinary obstetric and cardiology follow-up monitored fetal growth, leading to cesarean delivery and subsequent elective percutaneous balloon mitral commissurotomy at 6 months postpartum.
Initial echocardiography demonstrated severe rheumatic mitral stenosis with a mitral valve area of 1.06 cm2, a mean gradient of 12 mm Hg, and a systolic pulmonary artery pressure of 70 mm Hg.
Intrauterine growth restriction detected at 35 weeks and 5 days of gestation prompted hospital admission, corticosteroid administration, and an uncomplicated cesarean section delivering a healthy infant.
Percutaneous balloon mitral commissurotomy at 6 months postpartum increased the mitral valve area to 1.60 cm2 with posteromedial commissure splitting and without increasing mitral regurgitation severity.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 pregnant woman (age 28, 26 weeks of gestation) with previously unknown severe rheumatic mitral stenosis (MVA 1.06 cm², NYHA class IV) followed for 1 year postpartum.

I

Intervention

Initial conservative medical management during pregnancy (metoprolol, intravenous furosemide, and supplemental oxygen therapy), cesarean section at 35 weeks and 5 days due to intrauterine growth restriction, followed by percutaneous balloon mitral commissurotomy (PBMC) 6 months postpartum and long-term penicillin every 21 days plus metoprolol.

O

Outcome

Maternal and fetal clinical outcomes, symptomatic improvement, and post-PBMC mitral valve area at up to 1 year postpartum.

This case illustrates that conservative medical management of severe rheumatic mitral stenosis during pregnancy can bridge patients to safe delivery when symptoms respond to therapy, allowing definitive percutaneous balloon mitral commissurotomy to be deferred to the postpartum period.

Limitations

Single patient case report
Conservative management during pregnancy did not resolve left heart obstruction and was complicated by intrauterine growth restriction requiring preterm cesarean delivery

Implication

May support medical bridging to delivery in responsive severe rheumatic MS; leaves open need for prospective data before practice change.

Abstract

A 28-year-old woman, gravida 2 para 1, with previously unknown severe rheumatic mitral stenosis presented with progressive dyspnea at 26 weeks of gestation. Percutaneous commissurotomy was considered but was deferred after symptom improvement with beta-blockers and diuretics. Pregnancy complications ensued, requiring preterm delivery. Postpartum percutaneous commissurotomy was successful, highlighting the complexities in managing rheumatic heart disease during pregnancy.

Discussion

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Cite This Study

Mutarelli et al. (2024) conducted a case report in Severe rheumatic mitral stenosis during pregnancy (n=1). Medical therapy (metoprolol, intravenous furosemide, oxygen) during pregnancy followed by postpartum percutaneous balloon mitral commissurotomy (PBMC) was evaluated on Mitral valve area and symptomatic improvement after postpartum percutaneous balloon mitral commissurotomy.

synapsesocial.com/papers/6a777c94249abce98a1e70af https://doi.org/10.1016/j.jaccas.2024.102634

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Severe Rheumatic Mitral Stenosis During Pregnancy

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Severe Rheumatic Mitral Stenosis During Pregnancy

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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