Key result
Planned delivery and anticoagulation enable successful percutaneous mitral commissurotomy in severe MS with LA thrombus.
Why the study?
Mitral stenosis during pregnancy is a high-risk condition due to gestational hemodynamic changes that can worsen transmitral obstruction and cause decompensation.
Case Report (n=1)
Highlights the extreme hemodynamic risks of severe mitral stenosis during pregnancy and demonstrates the successful use of percutaneous mitral commissurotomy postpartum once left atrial thrombus has resolved.
Supports individualized management of severe MS in late pregnancy; leaves open optimal intervention timing in complex cases.
Background: Mitral stenosis (MS) during pregnancy remains a high-risk valvular condition because gestational increases in blood volume, heart rate and cardiac output can intensify transmitral obstruction and precipitate decompensation. Aims: This case report describes the management of very severe MS identified late in pregnancy and complicated by atrial fibrillation, left atrial thrombus, severe pulmonary hypertension and preterm delivery. Presentation of Case: A 43-year-old woman, gravida 5 para 2, was admitted at 27 weeks of gestation for exertional dyspnoea. Echocardiography revealed very severe MS (mitral valve area 0.6 cm², mean gradient 18 mmHg), a severely dilated left atrium (area 34 cm²), new-onset atrial fibrillation, a fresh left atrial thrombus (15×15 mm), and pulmonary arterial systolic pressure of 60 mmHg. Despite anticoagulation, the patient delivered prematurely at 28 weeks. The postpartum course was complicated by acute pulmonary oedema, and percutaneous mitral commissurotomy (PMC) was performed after thrombus resolution. Discussion: Haemodynamic changes of pregnancy dramatically worsen severe MS. Transoesophageal echocardiography (TEE) is indispensable for excluding left atrial thrombus before PMC. Anticoagulation, rate control, and a multidisciplinary approach are the cornerstones of management. Conclusion: PMC remains the treatment of choice for symptomatic severe MS in pregnancy when medical therapy fails, provided left atrial thrombus is excluded or resolved. Preconception counselling should be promoted in rheumatic disease-endemic regions.
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Bentama et al. (2026) conducted a case report in Severe Mitral Stenosis complicating pregnancy (n=1). Percutaneous mitral commissurotomy and medical management was evaluated. A 43-year-old pregnant woman with severe mitral stenosis and left atrial thrombus was managed with anticoagulation and premature delivery, followed by successful percutaneous mitral commissurotomy.
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