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Hussein A, Eid M, Mahmoud SED, Sabry M, Altaher A. The Outcomes of PBMV in Pregnancy, and When is the Best Time? Vasc Health Risk Manag 2023; 19:13-20. [PMID: 36687312 PMCID: PMC9849788 DOI: 10.2147/vhrm.s388754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
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.
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Affiliation(s)
- Ahmed Hussein
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt,Correspondence: Ahmed Hussein, Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University, Nasser City, Sohag, 82524, Egypt, Tel +2 01011145537, Fax +2 0934600349, Email
| | - Mohamed Eid
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt
| | - Sharaf E D Mahmoud
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt
| | - Mohamed Sabry
- Department of OB/GYN, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt
| | - Ali Altaher
- Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Sohag University Egypt, Sohag, Egypt
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Lima NDA, Patel DA, Sundaram N, de Castro RL, Huffman C, Diaz M, Linares ST, Melgar TA. Hospital admissions for mitral stenosis in pregnancy in the United States: a thirteen-year analysis. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:10-20. [PMID: 36938518 PMCID: PMC10017922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/28/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Cardiac conditions are a significant cause of maternal morbidity and mortality, significantly exacerbated during the hemodynamic demands of pregnancy. Mitral stenosis in pregnancy (MSp) is rare in the USA however, it has a high risk for maternal complications. METHODS We aim to outline the burden of MSp hospitalizations nationally. A retrospective review of HCUP/NIS data from 2002-2014 was conducted. RESULTS There were 2014 weighted discharges for both pregnancy and mitral stenosis (MS). Patients diagnosed with MS had a more considerable mean cost per discharge than the comparison group. Pulmonary Hypertension (PH), Atrial Arrhythmias (AA), Stroke, and Heart Failure (HF) were respectively reported in 25.71%, 7.14%, 0.95%, and 19.28% of the discharges. Our study identified a low incidence of MS in the US over the 12-year period; no deaths were identified. CONCLUSION Our results substantiate MSp as a risk factor for PH, AA, HF, and stroke in pregnancy. Even though the mortality is low, it is essential that clinicians be aware of this diagnosis due to higher associated morbidity and costs.
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Affiliation(s)
- Neiberg de Alcantara Lima
- Division of Cardiology, Department of Internal Medicine-Wayne State University Detroit 48201, Michigan, USA
| | | | - Nikhil Sundaram
- Wayne State University School of Medicine Detroit 48201, Michigan, USA
| | | | - Cuyler Huffman
- Department of Statistics-Western Michigan University Homer Stryker MD School of Medicine Kalamazoo, Michigan, USA
| | - Mireya Diaz
- Department of Statistics-Western Michigan University Homer Stryker MD School of Medicine Kalamazoo, Michigan, USA
| | - Silvia Teresa Linares
- Department of Obstetrics and Gynecology-Western Michigan University Homer Stryker MD School of Medicine Kalamazoo, Michigan, USA
| | - Thomas A Melgar
- Departments of Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine Kalamazoo, Michigan, USA
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Immediate maternal and fetal outcome following percutaneous mitral valve balloon commissurotomy: a 6-year single-center experience from sub-Saharan Africa. Cardiol Young 2022; 32:1616-1620. [PMID: 35129101 DOI: 10.1017/s1047951121004716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mitral stenosis is the most common valvular heart disease during pregnancy. When severe, it leads to significant maternal and fetal morbidity and mortality. Percutaneous mitral valve balloon commissurotomy can be performed during pregnancy, and the present study aimed to describe the immediate maternal and fetal outcomes after percutaneous mitral valve balloon commissurotomy was done in a cohort of 23 pregnant patients with severe mitral stenosis in Addis Ababa, Ethiopia. METHODS Included in the current study were all pregnant mothers who had severe rheumatic mitral valve stenosis and who underwent percutaneous mitral valve balloon commissurotomy at the Cardiac Center of Ethiopia over 6-year period. Data were collected through chart abstraction using a structured proforma and then analysed using STATA version 13.0. RESULT Median gestational age was 22 weeks and percutaneous mitral valve balloon commissurotomy was successful resulting in a significant increase in the mean mitral valve area of the group from 0.78 ± 0.20 cm2 to 1.89 ± 0.31 cm2 (p < 0.001). The mean mitral valve inflow gradient of the group was 23.95 ± 6.27 mmHg and 6.80 ± 2.44 mmHg, respectively, before and after the percutaneous mitral valve balloon commissurotomy procedure (p < 0.001). Post-procedure, there was no significant increment in mitral valve incompetence. The mean pulmonary artery pressure of the group decreased from 77.68 ± 23.19 mmHg to 42.31 ± 9.95 mmHg (p < 0.001). There was no fetal or maternal death following the procedure. Pregnancy ended at term gestation for 19/23 (82.6%) of the mothers and the mean birth weight of the neonates was 2800 g. CONCLUSION Percutaneous mitral valve balloon commissurotomy procedure can safely be done for severe symptomatic rheumatic mitral stenosis in pregnancy in our setting.
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Turi ZG. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100087. [PMID: 37288059 PMCID: PMC10242581 DOI: 10.1016/j.shj.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/09/2023]
Abstract
Percutaneous balloon mitral valvuloplasty (PBMV), once the most complex of percutaneous cardiac procedures and essentially the first adult structural heart intervention, set the stage for a host of new technologies. Randomized studies comparing PBMV to surgery were the first to provide a high-level evidence base in structural heart. The devices used have changed little in 40 years, but the advent of improved imaging and the expertise gained in interventional cardiology has provided some additional procedural safety. However, with the decline in rheumatic heart disease, PBMV is being performed in fewer patients in industrialized nations; in turn, these patients have more comorbidities, less favorable anatomy, and thus a higher rate of procedure-related complications. There remain relatively few experienced operators, and the procedure is distinct enough from the rest of the structural heart intervention world that it has its own steep learning curve. This article reviews the use of PBMV in a variety of clinical settings, the influence of anatomic and physiologic factors on outcomes, the changes in the guidelines, and alternative approaches. PBMV remains the procedure of choice in patients with mitral stenosis with ideal anatomy and a useful tool in patients with less than ideal anatomy who are poor surgical candidates. In the 40 years since its first performance, PBMV has revolutionized the care of mitral stenosis patients in developing countries and remains an important option for suitable patients in industrialized nations.
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Affiliation(s)
- Zoltan G. Turi
- Address correspondence to: Zoltan G. Turi, MD, Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ 07601.
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Khanal S, Yamasandi Siddegowda S, Kumar B. Balloon Mitral Valvotomy With the Accura Double-Lumen Balloon Catheter: Immediate and One-Year Clinical Outcomes. Cureus 2022; 14:e24610. [PMID: 35651439 PMCID: PMC9138188 DOI: 10.7759/cureus.24610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Despite the decline in the incidence of rheumatic heart disease in developed countries, the disease still remains endemic among individuals of low socioeconomic status. The aim of the study is to assess immediate and one-year outcomes of balloon mitral valvotomy using the double-lumen Accura balloon (Vascular Innovations Co., Nonthaburi, Thailand) in patients with mitral valve stenosis. Methods This was a single-centre, observational, investigator-initiated retrospective study. All consecutive patients undergoing balloon mitral valvotomy with the Accura balloon between January 2015 and June 2020 were included. The primary endpoint was procedural success defined as an increase in mitral valve area (MVA) ≥50% from basal valve area or final valve area of ≥1.5 cm2, in the absence of mitral regurgitation grade >2. Clinical, echocardiographic, and haemodynamic parameters were assessed at the one-year follow-up. Results A total of 62 patients underwent balloon mitral valvotomy. The mean age was 34.9 ± 8.0 years, and 54 (87.1%) patients were female. Mean Wilkins' echo score was 7.5 ± 0.5. Procedural success was achieved in 59 (96.7%) patients. Mean MVA increased from 0.75 ± 0.14 cm2 to 1.64 ± 0.21 cm2, and mean mitral valve gradient decreased from 24.9 ± 5.5 mmHg to 7.30 ± 1.40 mmHg. Atrial fibrillation, mitral valve replacement, and moderate to severe mitral regurgitation occurred in 36 (59.0%), two (3.3%), and two (3.3%) patients, respectively. No death, cerebrovascular accidents, restenosis, or redo procedures occurred. Conclusion Balloon mitral valvotomy using the double-lumen Accura balloon is safe in patients with mitral valve stenosis.
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Liaw J, Walker B, Hall L, Gorton S, White AV, Heal C. Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis. PLoS One 2021; 16:e0253581. [PMID: 34185797 PMCID: PMC8241043 DOI: 10.1371/journal.pone.0253581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/08/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy. Methods Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529). Findings The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54–5.33), and perinatal death (6 studies, RR 3.23, 1.92–5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02–4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02–5.95). Interpretation RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.
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Affiliation(s)
- Joshua Liaw
- College of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
- * E-mail:
| | - Betrice Walker
- College of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Leanne Hall
- College of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Susan Gorton
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Andrew V. White
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Clare Heal
- College of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 515] [Impact Index Per Article: 171.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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9
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 716] [Impact Index Per Article: 238.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Chuzi S, Eucalitto P, Yee LM. A Pregnant Woman With Shortness of Breath. JAMA Cardiol 2020; 6:113-114. [PMID: 33175087 DOI: 10.1001/jamacardio.2020.5587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick Eucalitto
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sreerama D, Surana M, Moolchandani K, Chaturvedula L, Keepanasseril A, Keepanasseril A, Pillai AA, Nair NS. Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2020; 100:666-675. [PMID: 33070306 DOI: 10.1111/aogs.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study was to systematically review the maternal and fetal outcomes in pregnant women who underwent percutaneous balloon mitral valvuloplasty (PBMV) during pregnancy. MATERIAL AND METHODS A search was conducted on MEDLINE and Embase databases to identify studies published between 2000 and 2018 that reported on maternal and fetal outcomes following PBMV performed in pregnancy. Randomized controlled trials, cohort studies, case-control studies, cross-sectional studies and case series with four or more pregnancies in which PBMV was performed during pregnancy were included. Reference lists from relevant articles were also hand-searched for relevant citations. A successful procedure was defined as one where there was a reported improvement in the valve area or reduction in the mitral valve gradient. A random effects model was used to derive pooled estimates of various outcomes and the final estimates were reported as percentages with a 95% confidence interval (95% CI). RESULTS Twenty-one observational studies reporting 745 pregnancies were included in the review, all of them having reported outcomes without a comparison group. Most of the studies fell into the low-risk category as determined using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. Most of the studies (86%) were reported from low- to middle-income countries and PBMV was mostly performed during the second trimester of pregnancy. Forty-three procedures (5.7%) were unsuccessful, nearly half (n = 19) of them reported among women with the severe subvalve disease (Wilkins subvalve score 3 or more). There were 11 maternal deaths among those with suboptimal valve anatomy (severe subvalve disease or Wilkin score >8). Mitral regurgitation was the most common cardiac complication (12.7%; 95% CI 7.3%-19.1%), followed by restenosis (2.4%; 95% CI 0.02%-7.2%). Pooled incidence of cesarean section was 12.1% (95% CI 3.6%-23.8%), preterm delivery 3.9% (95% CI 0.6%-9.0%), stillbirth 0.9% (95%CI 0.2%-2.2%) and low birthweight 5.4% (95% CI 0.2%-14.7%). CONCLUSIONS PBMV may be an effective and safe procedure for optimizing outcomes in pregnant women with mitral stenosis in the absence of severe subvalve disease.
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Affiliation(s)
- Damini Sreerama
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Mahak Surana
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Kailash Moolchandani
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Latha Chaturvedula
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Arun Keepanasseril
- School of Dentistry, Amrita Institute of Medical Sciences, Kochi, India.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ajith A Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil.,Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil.,Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil.,Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil,Hospital Barão de Lucena, Recife, PE – Brazil,Hospital EMCOR, Recife, PE – Brazil,Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil.,Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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Chatterjee K, Khanna R, Sahu A, Kumar S, Garg N, Tewari S, Kapoor A, Goel PK. Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy. Indian Heart J 2020; 72:248-251. [PMID: 32861378 PMCID: PMC7474116 DOI: 10.1016/j.ihj.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/27/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives To study the immediate maternal and fetal outcomes and long term maternal outcomes in pregnant women undergoing balloon mitral valvotomy. Methods We retrospectively analyzed balloon mitral valvotomy during pregnancy performed between January 2008 and July 2018. Results BMV was carried out in 97 pregnant women with mean age of 26.1 ± 4.5 years, at mean gestational age of 23.1 ± 4.6 weeks. The procedure was successful in 95 patients (97.9%). There was one maternal death post procedure due to intra-uterine death and disseminated intravascular coagulation. Adverse immediate fetal outcome was seen in 2 cases with one intra-uterine fetal demise and one preterm labour. Mitral valve area increased from mean of 0.82 ± 0.12 cm to 1.66 ± 0.14 cm (p < 0.001). Mean trans-mitral diastolic gradient decreased from 19.7 ± 5.6 mm Hg to 7.5 ± 2 mm Hg. Right ventricular systolic pressure decreased significantly from mean of 56.7 ± 16.2 mm Hg to mean of 35.6 ± 11 mm Hg. Survival analysis showed cumulative event free survival of 89% at 5 years and 65% at 10 years, considering a composite endpoint of clinical restenosis, repeat BMV or MVR or cardiovascular death. Conclusions Balloon mitral valvotomy is a safe and effective treatment for severe mitral stenosis during pregnancy. Long term maternal outcomes after BMV done during pregnancy are good and comparable to that of BMV done in non-pregnant patients.
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Affiliation(s)
- Krishnarpan Chatterjee
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ankit Sahu
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Naveen Garg
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Pravin K Goel
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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Cardiac interventions and cardiac surgery and pregnancy. Int J Cardiol 2019; 276:43-47. [DOI: 10.1016/j.ijcard.2018.09.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/25/2018] [Accepted: 09/25/2018] [Indexed: 01/12/2023]
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Botta I, Devriendt J, Rodriguez JC, Morissens M, Carling A, Gutierrez LB, Preseau T, De Bels D, Honore PM, Redant S. Cardiogenic Shock after Nifedipine Administration in a Pregnant Patient: A Case Report and Review of the Literature. J Transl Int Med 2018; 6:152-156. [PMID: 30425952 PMCID: PMC6231299 DOI: 10.2478/jtim-2018-0029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We present a case of a 21-year-old Caucasian woman at 27 weeks of pregnancy who was admitted to the obstetric department for pre-term labor. She received 10 mg of nifedipine 4 times in 1 h, according to the internal protocol. Shortly after, she brutally deteriorated with pulmonary edema and hypoxemia requiring transfer to the intensive care unit (ICU) for mechanical ventilation. She finally improved and was successfully extubated after undergoing a percutaneous valvuloplasty of the mitral valve. This case illustrates a severe cardiogenic shock after administration of nifedipine for premature labor in a context of unknown rheumatic mitral stenosis. Nifedipine induces a reflex tachycardia that reduces the diastolic period and thereby precipitates pulmonary edema in case of mitral stenosis. This case emphasizes the fact that this drug may be severely harmful and should never be used before a careful physical examination and echocardiography if valvular heart disease is suspected.
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Affiliation(s)
- Ilaria Botta
- Department of Cardiology, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
- Department of Intensive Care Medicine, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - Jacques Devriendt
- Department of Intensive Care Medicine, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - Jose Castro Rodriguez
- Department of Cardiology, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - Marielle Morissens
- Department of Cardiology, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - Andrew Carling
- Department of Obstetrics, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - Leonel Barreto Gutierrez
- Department of Intensive Care Medicine, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - Thierry Preseau
- Department of Emergency Medicine, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - David De Bels
- Department of Intensive Care Medicine, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - Patrick M. Honore
- Department of Intensive Care Medicine, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
| | - Sebastien Redant
- Department of Intensive Care Medicine, Brugmann University Hospital,
Université Libre de Bruxelles,
Brussels, Belgium
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Sharma JB, Yadav V, Mishra S, Kriplani A, Bhatla N, Kachhawa G, Kumari R, Toshayan V. Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. Indian Heart J 2018; 70:685-689. [PMID: 30392507 PMCID: PMC6204450 DOI: 10.1016/j.ihj.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Mitral stenosis due to rheumatic heart disease is a common problem in India causing significant morbidity and mortality. We have compared the maternal and fetal outcome of women with severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. METHODS A total of 24 women of severe rheumatic mitral stenosis who underwent balloon mitral valvotomy before pregnancy (14 women, group 1) or during pregnancy (10 women, group 2) were included in the retrospective descriptive analysis. RESULTS The mean age was 25.5±3.6 yrs in group 1 and 25.7±3.5 yrs in group 2. There was no difference in characteristics -primigravidas, time since diagnosis from pregnancy, NYHA (New York Heart Association) class and associated medical problems in the two groups. There was significant difference in cardiac events during pregnancy in the two groups. New York Heart Association class deterioration was observed in only 3(21.4% women in group 1) as compared to all (10; 100% women) in group 2(p<0.001). The incidence of arrhythmias and atrial fibrillation was not different in two groups. Obstetric events were similar in the two groups. Mode of delivery and caesarean section rate was also similar in the two groups. There was no significant difference in mean birth weights (2399.75±601.8gm vs. 2641.70±580.6gm),rate of fetal growth restriction, still birth and congenital malformation rates in the two groups. CONCLUSION Percutaneous mitral valvotomy for patients with severe mitral stenosis can be safely performed during pregnancy and has equivalent maternal and fetal outcomes as that performed before pregnancy.
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Affiliation(s)
- J B Sharma
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Vikas Yadav
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - S Mishra
- Department of Cardiology, AIIMS, New Delhi, India
| | - A Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Varnit Toshayan
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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Rheumatic Heart Disease Worldwide. J Am Coll Cardiol 2018; 72:1397-1416. [DOI: 10.1016/j.jacc.2018.06.063] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022]
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Pregnancy- Associated Changes in Pharmacokinetics and their Clinical Implications. Pharm Res 2018; 35:61. [DOI: 10.1007/s11095-018-2352-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
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Abstract
OPINION STATEMENT Valvular heart disease in women of childbearing age poses an increased risk of adverse maternal and fetal outcomes, and management in pregnancy can be challenging. Ideally, patients with suspected valvular disease should have preconception counseling by a multidisciplinary team including cardiologists with expertise in pregnancy and a maternal-fetal medicine specialist. Preconception planning should include a cardiac assessment of maternal risk, determination of frequency of surveillance, and a cardiovascular management plan during delivery. Women with valvular heart disease should be followed closely by a cardiologist and monitored for signs and symptoms of congestive heart failure and arrhythmias. In general, stenotic lesions may become more symptomatic in pregnancy, whereas regurgitant lesions are generally well tolerated. Left-sided valvular lesions have higher complication rates than right-sided lesions. For patients with asymptomatic valvular stenosis, medical management during pregnancy may include beta blockade and/or diuretics. Exercise stress testing prior to pregnancy in sedentary patients can be helpful to unmask symptoms and determine functional capacity. Patients with symptomatic, severe left-sided valvular obstruction have a high maternal risk of cardiovascular events during pregnancy, and percutaneous balloon valvuloplasty or surgery is recommended prior to pregnancy. The type of prosthetic valve (mechanical vs bioprosthetic) should be selected after a careful discussion with the patient. Invasive procedures are generally reserved for when medical management fails. The second trimester may be the optimal time for intervention as fetal organogenesis is complete and the cardiac positioning has not been affected by the gravid uterus.
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Affiliation(s)
- Lucy M Safi
- Echocardiography, Massachusetts General Hospital, Yawkey Building, 5B, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Sarah V Tsiaras
- Echocardiography, Massachusetts General Hospital, Yawkey Building, 5B, 55 Fruit Street, Boston, MA, 02114, USA
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