Closed mitral valvotomy during pregnancy. A 20-year experience.
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.
Pavankumar
P
P
Department of Cardiothoracic, All India Institute of Medical Sciences, New Delhi.
Venugopal
P
P
Kaul
U
U
Iyer
K S
KS
Das
B
B
Sampathkumar
A
A
Airon
B
B
Rao
I M
IM
Sharma
M L
ML
Bhatia
M L
ML
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