Key result
Percutaneous balloon mitral valvuloplasty significantly reduced the mean pressure gradient from 17.22 to 8.94 mmHg (P<0.001), with better obstetric outcomes observed with second-trimester intervention.
Why the study?
The optimal timing during pregnancy to perform PBMV for symptomatic severe mitral valve stenosis to achieve the best maternal and fetal outcomes is unknown.
Does percutaneous balloon mitral valvuloplasty (PBMV) during the second trimester improve obstetric outcomes compared to the third trimester in pregnant patients with symptomatic severe mitral stenosis?
Observational (n=44)
No
Does percutaneous balloon mitral valvuloplasty (PBMV) during the second trimester improve obstetric outcomes compared to the third trimester in pregnant patients with symptomatic severe mitral stenosis?
Performing percutaneous balloon mitral valvuloplasty during the second trimester of pregnancy in patients with symptomatic severe mitral stenosis yields better obstetric outcomes than performing it in the third trimester.
Answers are grounded in this paper and cite their sources.
Second-trimester PBMV was associated with fewer preterm deliveries and fetal deaths in symptomatic MS; leaves optimal timing open for randomized confirmation.
Background: Percutaneous balloon mitral valvuloplasty (PBMV) is considered the most suitable option for managing symptomatic severe mitral valve stenosis (MS) during pregnancy with favorable anatomy. We do not know the best time to perform PBMV during pregnancy to achieve the best maternal and fetal outcomes. Therefore, we conducted this study to clarify the best procedure timing. Methods: This prospective, observational, single-center study involved 44 pregnant patients suffering from symptomatic MS who underwent PBMV from May 2017 to May 2020. A detailed history is taken, full clinical examination, laboratory assessment, 2 D echocardiography, and follow-up during the hospital stay and monthly until labor. Results: (P < 0.001). The mean pressure gradient across the mitral valve reduced from 17.22 ± 5.55 to 8.94 ± 3.75 mmHg (P < 0.001). The procedures were successful in 91% of the patients. Regarding obstetric outcomes, the incidence of preterm labor, fetal death, and composite adverse outcomes was significantly lower in patients who had the procedure during the second trimester than those who had the procedure during the third trimester. All preterm deliveries and intrauterine fetal deaths occurred at least 21 days after PBMV. The patients showed a statistically significant improvement in NYHA functional classification. Conclusion: We can conclude that PBMV performed in pregnant patients is an effective and safe treatment modality, and we observed better obstetric outcomes achieved with early intervention during the second trimester.
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Hussein et al. (2023) conducted an observational in symptomatic severe mitral valve stenosis during pregnancy (n=44). Percutaneous balloon mitral valvuloplasty (PBMV) vs. Pre-procedure baseline / Third trimester intervention was evaluated on Mean pressure gradient across the mitral valve (mmHg) (p=<0.001). Percutaneous balloon mitral valvuloplasty significantly reduced the mean pressure gradient from 17.22 to 8.94 mmHg (P<0.001), with better obstetric outcomes observed with second-trimester intervention.
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