OUTCOMES OF PERCUTANEOUS TRANSLUMINAL MITRAL COMMISSUROTOMY (PTMC) FOR SEVERE MITRAL STENOSIS IN PREGNANCY

Abstract

Objective: To know short term outcomes of PTMC for severe isolated mitralstenosis in pregnancy.

Methodology: This observational study was performed in Cardiology Unit ofLady Reading Hospital Peshawar from January 2003 to December 2014. Allpatients with symptomatic severe isolated mitral stenosis with no more thanmoderate degree mitral regurgitation were included in the study. They werefollowed till delivery.

Results: A total number of 36 pregnant patients undergoing PTMC for isolatedsevere mitral stenosis were included in the study. Mean age was 29±6.3 years.Mild mitral regurgitation was found in 18(50%) of patients, moderate mitralregurgitation in 3(8.3%) while there was no mitral regurgitation in 15(41.7%)patients. Mean mitral valve area was 0.8±0.36 cm . Mean mitral valve gradientwas 23±11 mm of Hg. There mean left atrium size was 4.7±1.2cm. Meanejection fraction was 58.43%. Mean pulmonary artery pressure was 45.8±16.4mmof Hg. PTMC was performed in second trimester in 32(88.88%) patients andin third trimester in 4(11.11%) patients. PTMC was successful in 33(91.6%).Post PTMC mitral valve area was 1.8±0.82cm . The mean mitral valve gradientwas 4±3.2 mm of Hg. Mean left atrium size was 4.61± 2.34 cm. Mild mitralregurgitation was found in 17(47.22%). Moderate mitral regurgitation was foundin 5(13.8%) of patients. Acute severe mitral regurgitation occurred in 1(2.7%)patient, for which emergency mitral valve replacement was arranged but expired.One (2.7%) had still birth. The mean fluoroscopy time was 9.3±7.2 minutes.

Conclusion: PTMC is safe and effective procedure for severe symptomatic mitralstenosis in pregnant patients.