Key result
A multidisciplinary cardio-obstetric approach, including a medical bridge to 28.1 weeks and postpartum mechanical mitral valve replacement, resulted in successful maternal and neonatal survival.
Why the study?
Severe rheumatic mitral stenosis is high-risk in pregnancy and particularly difficult to manage when unsuitable for percutaneous balloon mitral valvuloplasty and the patient declines termination.
Case Report (n=1)
In pregnant patients with severe rheumatic mitral stenosis unsuitable for percutaneous intervention, a multidisciplinary medical bridge to fetal viability followed by postpartum valve replacement can yield favorable maternal and neonatal outcomes.
May support bridging to viability in select pregnant patients with severe mitral stenosis; hypothesis-generating for optimal peripartum strategies.
Severe rheumatic mitral stenosis (MS) is one of the highest-risk valvular lesions in pregnancy, and it becomes particularly hard to manage when the valve is unsuitable for percutaneous balloon mitral valvuloplasty (PBMV) and the patient declines termination. We describe a 20-year-old primigravida who presented at 23.5 weeks of gestation with progressive dyspnea, having deteriorated from New York Heart Association (NYHA) class I to class III. Multimodality echocardiography confirmed severe rheumatic MS, with a valve area of 0.5 cm 2 by two-dimensional planimetry and 0.572 cm 2 by three-dimensional transesophageal planimetry, a mean transmitral gradient of 15 mmHg, and a Wilkins score of 13, together with severe left atrial dilatation and pulmonary hypertension. PBMV was not feasible. After a shared decision-making process that respected the patient's refusal of termination, a multidisciplinary cardio-obstetric team provided a medical bridge aimed at fetal viability. Acute pulmonary edema at 28.1 weeks led to cesarean delivery of a 940 g neonate, and the patient underwent uncomplicated mechanical mitral valve replacement two weeks postpartum. The case shows how shared decision-making, multidisciplinary care, and the timing of surgery after delivery can be combined to protect both mother and child.
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Trujillo et al. (2026) conducted a case report in Severe rheumatic mitral stenosis complicating pregnancy (n=1). Multidisciplinary cardio-obstetric care (medical bridge, cesarean delivery, postpartum valve replacement) was evaluated on Maternal and fetal survival. A multidisciplinary cardio-obstetric approach, including a medical bridge to 28.1 weeks and postpartum mechanical mitral valve replacement, resulted in successful maternal and neonatal survival.
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