Advances in the management of cardiovascular disease during pregnancy

Mitral Stenosis in Pregnancy: A Comprehensive Review of a Challenging Cardio-Obstetric Clinical Entity

BACKGROUND

Mitral stenosis is one of the most commonly encountered valvular heart diseases during pregnancy, the majority are rheumatic in origin and poorly tolerated due to cardiocirculatory changes that occur during pregnancy, labor and postpartum.

OBJECTIVE

The distinctive physiological events that arise during pregnancy and labor and the influence of mitral stenosis are tackled in this article.

METHODS

Through PUBMED and MEDLINE searches, we reviewed the literature of the last decade as well as the recommendations from guidelines of high-impact worldwide.

RESULTS

Cardiac decompensation usually takes place late in pregnancy as the hemodynamic burden of pregnancy become more pronounced as well as after delivery due to an abrupt increase of preload secondary to autotransfusion and aorto-caval decompression. The maternal and fetal complications correlate with the New York Heart Association (NYHA) functional classification and the grade of mitral stenosis. Medical therapy should be tried first. If symptoms continue in spite of optimal medical therapy, invasive procedures are recommended. Several studies revealed that vaginal delivery under epidural anesthesia is endurable and of low-risk unless obstetrically contraindicated.

CONCLUSION

Pregnancy and mitral stenosis remain a complex entity and a well-known trigger of maternal mortality during pregnancy and peri-partum period if not managed adequately. A good appreciation and recognition of the physiology of pregnancy and its impact on the pre-existing mitral stenosis and the presence of a specialized multidisciplinary team to handle such cases significantly decrease maternal and fetal mortality and morbidity.