title: Closed mitral valvotomy during pregnancy. A 20-year experience.
abstract: Closed mitral valvotomy for rheumatic mitral stenosis was performed on 126 pregnant women (average duration of pregnancy c. 21 weeks), 91% of whom were in NYHA functional class III or IV. Associated functional tricuspid regurgitation was present in 47 (37%) of the women, and 102 (81%) had critical mitral stenosis (digitally assessed valve area less than 1 cm2). There was no surgical mortality. Postoperatively 84% of the women were in NYHA class I. Clinical evidence of pulmonary artery hypertension and tricuspid regurgitation regressed postoperatively in most patients. Full-term normal delivery was achieved in 82% of the pregnancies, with total fetal mortality 6%. There were no congenital abnormalities and the infants' progress was normal. At 5-year follow-up 86% of the women were in NYHA class I or II and at 10 years the figure was 60%. The restenosis rate was 2%/year and the late mortality 3.3%. Closed mitral valvotomy during pregnancy thus was safe and reliable, giving significant functional and clinical improvement without adversely affecting the fetus.
authors.affiliation: Department of Cardiothoracic, All India Institute of Medical Sciences, New Delhi.
authors.forename: P
authors.initials: P
authors.lastname: Pavankumar
authors.forename: P
authors.initials: P
authors.lastname: Venugopal
authors.forename: U
authors.initials: U
authors.lastname: Kaul
authors.forename: K S
authors.initials: KS
authors.lastname: Iyer
authors.forename: B
authors.initials: B
authors.lastname: Das
authors.forename: A
authors.initials: A
authors.lastname: Sampathkumar
authors.forename: B
authors.initials: B
authors.lastname: Airon
authors.forename: I M
authors.initials: IM
authors.lastname: Rao
authors.forename: M L
authors.initials: ML
authors.lastname: Sharma
authors.forename: M L
authors.initials: ML
authors.lastname: Bhatia
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011183:Postoperative Complications; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*; D011256:Pregnancy Outcome; D014693:Ventricular Fibrillation / Q000209:etiology