Key result
Medical therapy enables successful 36-week delivery in severe mitral stenosis with heart failure.
Why the study?
Pregnancy frequently causes decompensation of stenosing valvular heart disease in young women, complicating management of heart failure due to severe mitral stenosis.
Case Report (n=1)
No
In resource-limited settings where percutaneous mitral commissurotomy is unavailable, severe mitral stenosis during pregnancy can be managed with careful medical therapy and multidisciplinary follow-up to achieve successful maternal and fetal outcomes.
Answers are grounded in this paper and cite their sources.
May support medical management for severe mitral stenosis in pregnancy where interventions unavailable; hypothesis-generating case evidence requiring prospective validation.
RÉSUMÉLa grossesse est un facteur de décompensation fréquent des valvulopathies sténosantes chez la femme jeune. Nous rapportons une difficulté de prise en charge d’insuffisance cardiaque sur rétrécissement mitral serré, diagnostiqué au cours de la grossesse. Une gestante de 20 sa a été vue en consultation pour dyspnée d’aggravation progressive. Elle présentait à l’examen clinique un syndrome d’insuffisance cardiaque globale avec de volumineux œdèmes des membres inférieurs, associés à une orthopnée. L’échocardiographie a montré un rétrécissement mitral serré avec un gradient moyen à 16 mmHg, une HTP à 84 mmHg. L’évolution sous traitement médical fait de diurétique de l’anse et Métoprolol a été marquée par la persistance des signes congestifs et un passage en fibrillation atriale rapide. Une dilatation mitrale percutanée était indiquée, mais non réalisable dans notre pays. Des ajustements thérapeutiques et un suivi multidisciplinaire ont permis la naissance d’un enfant vivant en bonne santé apparente à 36 sa. La prise en charge du RM serré chez la femme enceinte reste un défi pour les pays à faible plateau technique. ABSTRACT Pregnancy is a frequent factor in the decompensation of stenosing valve disease in young women. Our case reports difficulties in the management of heart failure due to tight mitral stenosis diagnosed during pregnancy. A 20 week pregnant woman was seen in consultation for progressively worsening dyspnoea. Clinical examination revealed congestive heart failure with extensive oedema of the lower limbs and orthopnoea. Echocardiography showed narrow mitral stenosis with a mean gradient of 16 mmHg and pulmonary hypertension of 84 mmHg. Course with medical treatment associating loop diuretics and metoprolol was marked by persistent congestive signs and rapid transition to atrial fibrillation. Percutaneous mitral dilatation was indicated, but not available locally. Therapeutic adjustments and multidisciplinary follow-up resulted in the birth of a healthy child at 36 weeks. The management of severe mitral stenosis in pregnant women is still a challenge for countries with low technical resources.
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JM et al. (2023) conducted a case report in Heart failure secondary to severe mitral stenosis during pregnancy (n=1). Medical management (diuretics, metoprolol, digoxin, enoxaparin) was evaluated on Clinical outcome (maternal and fetal survival). Medical management with diuretics and beta-blockers allowed for the successful delivery of a healthy infant at 36 weeks gestation in a pregnant woman with severe mitral stenosis and heart failure.
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