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Elkayam U, Bansal P, Mehra A. Catheter-Based Interventions for the Management of Valvular Heart Disease During Pregnancy. JACC. ADVANCES 2022; 1:100022. [PMID: 38939308 PMCID: PMC11198064 DOI: 10.1016/j.jacadv.2022.100022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 06/29/2024]
Abstract
Pregnancy is associated with a significant increase in hemodynamic burden. These changes can lead to maternal morbidity and mortality as well as unfavorable fetal outcomes in patients with valvular heart disease and limited cardiac reserve. Mechanical interventions may be needed for the management of severe hemodynamic deterioration not responding to medical therapy. Catheter-based percutaneous interventions can provide an alternative therapy to surgery during pregnancy. The purpose of this article is to review indications, potential advantages, and limitations of catheter-based interventions for the management of women with valvular heart disease in pregnancy.
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Affiliation(s)
- Uri Elkayam
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Priya Bansal
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anil Mehra
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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2
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Talawar P, Rajeshwari S, Kumar S, Bhoi D. Rescue percutaneous balloon mitral valvotomy before caesarean section. Indian J Anaesth 2021; 65:S92-S93. [PMID: 34188262 PMCID: PMC8191191 DOI: 10.4103/ija.ija_1032_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Praveen Talawar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - S Rajeshwari
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailendra Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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Firouzi A, Samiei N, Ahmadi S, Naderi N, Sadeghipour P, Sanati HR, Kashfi F, Sattarzadeh R, Hantoushzadeh S, Bayat M, Pourtaghi S, Nasiri M. Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis. J Tehran Heart Cent 2019; 14:12-17. [PMID: 31210765 PMCID: PMC6560256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Mitral stenosis tends to worsen during pregnancy because of the increase in the cardiac output and the heart rate. In nonresponders to medical therapy, percutaneous transluminal mitral commissurotomy (PTMC) may be performed when there is a suitable valvular anatomy. In this study, we aimed to investigate the clinical and fetal outcomes of pregnant women with mitral stenosis who underwent PTMC. Methods: Thirty-one patients undergoing PTMC during pregnancy were enrolled in this study. The mitral valve area (MVA), the transmitral valve mean gradient (MVMG), and the severity of mitral regurgitation were assessed pre- and postprocedurally by transthoracic and transesophageal echocardiography. The radiation time was measured during the procedure. The patients were followed up during pregnancy, and the neonates were monitored for weight, height, the head circumference, the birth Apgar score, and the adverse effects of radiation for at least 12 months. Results: PTMC was successfully performed on 29 (93.5%) patients. No maternal death or pulmonary edema was reported. The mean MVA significantly increased (from 0.73±0.17 cm2 to 1.28±0.24 cm2; P<0.001), and the mean MVMG significantly decreased (from 19.62±5.91 mmHg to 8.90±4.73 mmHg; P<0.001) after the procedure. A significant decrease in the systolic pulmonary artery pressure was also detected. Mitral regurgitation did not increase in severity in 16 (51.6%) patients. There was no significant relationship between the Apgar score, weight, height, and the head circumference at birth and at the radiation time. Conclusion: In our series, PTMC during pregnancy was a safe and effective procedure. Lowering the radiation time with low frame-count techniques confers a significant decrease in radiation-related complications.
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Affiliation(s)
- Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Niloufar Samiei, Associate Professor of Cardiology, Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Vali-Asr Ave., Tehran, Iran. 1996911101. Tel: +98 21 23922161. Fax: +98 21 23922340.E-mail: .
| | - Somayyeh Ahmadi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Naderi
- Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Sanati
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Kashfi
- Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Sattarzadeh
- Echocardiography Laboratory, Department of Cardiovascular Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Maternal, Fetal and Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bayat
- Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
| | - Sanaz Pourtaghi
- Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
| | - Mohsen Nasiri
- Rajaie Cardiovascular, Medical, and Research Center, Iran university of Medical Sciences, Tehran, Iran.
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Sharma JB, Yadav V, Mishra S, Kriplani A, Bhatla N, Kachhawa G, Kumari R, Toshayan V. Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. Indian Heart J 2018; 70:685-689. [PMID: 30392507 PMCID: PMC6204450 DOI: 10.1016/j.ihj.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Mitral stenosis due to rheumatic heart disease is a common problem in India causing significant morbidity and mortality. We have compared the maternal and fetal outcome of women with severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. METHODS A total of 24 women of severe rheumatic mitral stenosis who underwent balloon mitral valvotomy before pregnancy (14 women, group 1) or during pregnancy (10 women, group 2) were included in the retrospective descriptive analysis. RESULTS The mean age was 25.5±3.6 yrs in group 1 and 25.7±3.5 yrs in group 2. There was no difference in characteristics -primigravidas, time since diagnosis from pregnancy, NYHA (New York Heart Association) class and associated medical problems in the two groups. There was significant difference in cardiac events during pregnancy in the two groups. New York Heart Association class deterioration was observed in only 3(21.4% women in group 1) as compared to all (10; 100% women) in group 2(p<0.001). The incidence of arrhythmias and atrial fibrillation was not different in two groups. Obstetric events were similar in the two groups. Mode of delivery and caesarean section rate was also similar in the two groups. There was no significant difference in mean birth weights (2399.75±601.8gm vs. 2641.70±580.6gm),rate of fetal growth restriction, still birth and congenital malformation rates in the two groups. CONCLUSION Percutaneous mitral valvotomy for patients with severe mitral stenosis can be safely performed during pregnancy and has equivalent maternal and fetal outcomes as that performed before pregnancy.
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Affiliation(s)
- J B Sharma
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Vikas Yadav
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - S Mishra
- Department of Cardiology, AIIMS, New Delhi, India
| | - A Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Varnit Toshayan
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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Rathakrisnnan SS, Ramasamy R, Kaliappan T, Gopalan R, Palanimuthu R, Anandhan P. Immediate Outcome of Balloon Mitral Valvuloplasty with JOMIVA Balloon during Pregnancy. J Clin Diagn Res 2017; 11:OC18-OC20. [PMID: 28384909 DOI: 10.7860/jcdr/2017/24234.9345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rheumatic mitral stenosis is the most common Valvular Heart Disease encountered during pregnancy. Balloon Mitral Valvuloplasty (BMV) is one of the treatment option available if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. BMV with Inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique using Joseph Mitral Valvuloplasty (JOMIVA) balloon catheter which is being followed in certain centres. AIM To assess the immediate post procedure outcome of over the wire BMV with JOMIVA balloon. MATERIALS AND METHODS Clinical and echocardiographic parameters of pregnant women with significant mitral stenosis who underwent elective BMV with JOMIVA balloon in our institute from 2005 to 2015 were analysed retrospectively. Severity of breathlessness (New York Heart Association Functional Class), and duration of pregnancy was included in the analysis. Pre procedural echocardiographic parameters which included severity of mitral stenosis and Wilkin's scoring were analysed. Clinical, haemodynamic and echocardiographic outcomes immediately after the procedure were analysed. RESULTS Among the patients who underwent BMV in our Institute 38 were pregnant women. Twenty four patients (63%) were in New York Heart Association (NYHA) Class III. All of them were in sinus rhythm except two (5%) who had atrial fibrillation. Thirty four patients (89.5%) were in second trimester of pregnancy at the time of presentation and four (10.5%) were in third trimester. Echocardiographic analysis of the mitral valve showed that the mean Wilkin's score was 7.3. Mean mitral valve area pre procedure was 0.8 cm2. Mean gradient across the valve was 18 mmHg. Ten patients (26.5%) had mild mitral regurgitation and none had more than mild mitral regurgitation. Thirty six patients had pulmonary hypertension as assessed by tricuspid regurgitation jet velocity. All of them underwent BMV with JOMIVA balloon. Post procedure mean mitral valve area was 1.7 cm2 as assessed by echocardiography. Post procedure mean gradient across the mitral valve as assessed by echocardiography was 5 mmHg. Two patients had moderate to severe mitral regurgitation after the procedure and the rest had either no mitral regurgitation or mild mitral regurgitation after the procedure. None of the patients warranted mitral valve replacement after BMV. No patients had any manifestations of systemic embolism like cerebrovascular accident or limb ischemia after the procedure. None of the patients had preterm delivery or adverse fetal outcome during index hospitalisation. CONCLUSION Over the wire BMV is safe and effective method during pregnancy. The results are comparable to that of Inoue technique. BMV offers a good symptomatic improvement in pregnant women presenting with symptoms of pulmonary congestion because of Rheumatic mitral stenosis.
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Affiliation(s)
- Shanmuga Sundaram Rathakrisnnan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Ramona Ramasamy
- Resident, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Tamilarasu Kaliappan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Rajendiran Gopalan
- Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Ramasmy Palanimuthu
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
| | - Premkrishna Anandhan
- Assistant Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamil Nadu, India
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Joshi HS, Deshmukh JK, Prajapati JS, Sahoo SS, Vyas PM, Patel IV. Study of Effectiveness and Safety of Percutaneous Balloon Mitral Valvulotomy for Treatment of Pregnant Patients with Severe Mitral Stenosis. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2015; 9:OC14-7. [PMID: 26816932 DOI: 10.7860/jcdr/2015/14765.6923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In pregnant women mitral stenosis is the commonest cardiac valvular lesion. When it is present in majorly severe condition it leads to maternal and fetal morbidity and mortality. In mitral stenosis pregnancy can lead to development of heart failure. AIM To evaluate the safety and efficacy of balloon mitral valvulotomy (BMV) in pregnant females with severe mitral stenosis. MATERIALS AND METHODS A total of 30 pregnant patients who underwent BMV were included in the study from July 2011 to November 2013. Clinical follow-up during pregnancy was done every 3 months until delivery and after delivery. The mean follow up time after BMV was 6.72±0.56 months. RESULTS From the 30 pregnant females 14 (46.67%) and 16 (53.3%) patients underwent BMV during the third and second trimester of pregnancy respectively. The mean mitral valve area was 0.85+0.16 cm(2) before BMV that increased to 1.60+0.27 cm(2) (p<0.0001) immediately after BMV. Peak and mean diastolic gradients had decreased significantly within 48 hours after the procedure (p<0.001) but remained very much unchanged at 6.72 month period of follow-up. Two patients had an increase in mitral regurgitation by 2 grades. CONCLUSION During pregnancy BMV technique is safe and effective in patients with severe mitral stenosis. This results in marked symptomatic relief along with long term maternal and fetal outcomes.
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Affiliation(s)
- Hasit Sureshbhai Joshi
- Associate Professor, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Jagjeet Kishanrao Deshmukh
- Associate Professor, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Jayesh Somabhai Prajapati
- Head of Department, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Sibasis Shahsikant Sahoo
- Associate Professor, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Pooja Maheshbhai Vyas
- DM Resident, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Iva Vipul Patel
- Research Fellow, Department of Research, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
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Kapoor D, Choudhary F, Smith WHT, Wallace S. Percutaneous mitral commisurotomy during pregnancy - A report of two cases performed in a United Kingdom tertiary centre and a review of the literature. Obstet Med 2015; 8:195-9. [PMID: 27512481 PMCID: PMC4935054 DOI: 10.1177/1753495x15600571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/12/2015] [Indexed: 11/15/2022] Open
Abstract
We report two cases of severe mitral stenosis where percutaneous mitral commisurotomy was performed within pregnancy. The first case involves an emergency procedure for a new diagnosis of severe mitral stenosis in a woman presenting with pulmonary oedema at 27 weeks' gestation. The second case is of a woman known to have mitral stenosis who underwent a semi-elective procedure for deterioration in symptoms. This procedure is not commonly performed in the United Kingdom because of low incidence of rheumatic heart disease. In addition, percutaneous mitral commisurotomy during pregnancy is rarely performed in the United Kingdom because of the improved healthcare system where majority of the women with moderate to severe mitral stenosis (even asymptomatic) will undergo planned interventions (percutaneous mitral commisurotomy or mitral valve surgery) before contemplating pregnancy. These cases highlight both the acute and chronic presentations of mitral stenosis and the impact pregnancy has on this condition. In addition, these cases show the importance of retaining skills in performing percutaneous mitral commisurotomy within our United Kingdom cardiologists.
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Affiliation(s)
- Dipanwita Kapoor
- Department of Obstetrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ferrah Choudhary
- Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - William HT Smith
- Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Suzanne Wallace
- Department of Obstetrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
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