Highlights the significant maternal mortality risk associated with rheumatic mitral stenosis during pregnancy and introduces mitral commissurotomy as a potential intervention.
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High maternal mortality risk persists in rheumatic mitral stenosis; leaves open commissurotomy role pending prospective data.
In obstetric practice heart disease is one of the leading causes of maternal morbidity and mortality. Chronic rheumatic valvulitis constitutes 90 to 95% of the cardiac lesions that occur in pregnant women,1and in 75% of the patients there is involvement of the mitral valve alone, usually with mitral stenosis with or without mitral insufficiency.2For the most part, prognosis is based primarily on the threat or the presence of cardiac decompensation. In favorable cases (functional classes 1 and 2), in which cardiac decompensation is uncommon, the maternal mortality approaches 40 to 50% and cardiac decompensation accounts for 60 to 65% of the fatalities. Fortunately, the majority of patients (about 85% )3are in class 1 or 2, and here therapeutic abortion is seldom indicated. On the other hand, the maternal risk in class 3 and particularly in class 4 not infrequently prompts the obstetrician to resort to
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Denton A. Cooley (1952) studied this question.
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