Maternal Outcome in Mitral Valve Disease with Pulmonary Hypertension: Two Case Reports

Chronic rheumatic heart disease is still the leading cause of heart disease complicating pregnancy in the developing countries. The physiologic changes in pregnancy and stress induced by the increase in cardiac output can cause asymptomatic patients with mitral stenosis to decompensate, especially in the third trimester. Severity of mitral stenosis is reflected by the decrease in the valve area and increase in the right ventricular systolic pressures (RVSPs). Venous thromboembolism (VTE) is two to five times more common in the postpartum period, and the risk is high with cesarean delivery. Pulmonary embolism in pregnancy can cause severe maternal morbidity and mortality. We describe two cases of severe mitral stenosis complicating pregnancy with grossly elevated RVSP. The first case is the successful management of a second gravida, presenting with severe mitral stenosis with RVSP 80 mm Hg, and the second, a fatal case of a 26-year-old para 1, live 1, delivered by cesarean section, presenting with massive fatal pulmonary embolism on 13th postoperative day (POD) with RVSP 90 mm Hg. A multidisciplinary approach involving the cardiologist, obstetrician, and obstetric anesthesiologist is crucial for management of severe mitral stenosis complicating pregnancy, to decrease the maternal morbidity and mortality during peripartum period.