The Outcomes of PBMV in Pregnancy, and When is the Best Time?

Abstract

Background

Percutaneous balloon mitral valvuloplasty (PBMV) is considered the most suitable option for managing symptomatic severe mitral valve stenosis (MS) during pregnancy with favorable anatomy. We do not know the best time to perform PBMV during pregnancy to achieve the best maternal and fetal outcomes. Therefore, we conducted this study to clarify the best procedure timing.

Methods

This prospective, observational, single-center study involved 44 pregnant patients suffering from symptomatic MS who underwent PBMV from May 2017 to May 2020. A detailed history is taken, full clinical examination, laboratory assessment, 2 D echocardiography, and follow-up during the hospital stay and monthly until labor.

Results

We found that the mean mitral valve area (MVA) had significantly increased from 1.12 ± 0.24 to 2.09 ± 0.46 cm² (P < 0.001). The mean pressure gradient across the mitral valve reduced from 17.22 ± 5.55 to 8.94 ± 3.75 mmHg (P < 0.001). The procedures were successful in 91% of the patients. Regarding obstetric outcomes, the incidence of preterm labor, fetal death, and composite adverse outcomes was significantly lower in patients who had the procedure during the second trimester than those who had the procedure during the third trimester. All preterm deliveries and intrauterine fetal deaths occurred at least 21 days after PBMV. The patients showed a statistically significant improvement in NYHA functional classification.

Conclusion

We can conclude that PBMV performed in pregnant patients is an effective and safe treatment modality, and we observed better obstetric outcomes achieved with early intervention during the second trimester.

Keywords:

• rheumatic heart disease
• mitral stenosis
• PBMV
• pregnancy
• obstetric outcomes

Abbreviations

COP, cardiac output; LA, left atrium; MR, mitral regurge; MS, mitral stenosis; MVA, mitral valve area; NYHA, New York Heart Association; PASP, pulmonary artery systolic pressure; PBMV, percutaneous balloon mitral valvuloplasty.

Declarations

● Ethics approval and consent to participate: All subjects provided written informed consent to participate in the study. The study protocol was approved by:

1.Medical Research Ethics Committee, Sohag Faculty of Medicine, Sohag University. The committee reference number is not applicable. Date of approval, May 2017.

● Availability of data and materials: the datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

● Authors’ contributions: All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Acknowledgments

We thank all the patients who participated in this study. We thank all the cardiology unit and obstetric department staff at Sohag University Hospital.

Disclosure

The authors report no conflicts of interest for this work.