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Role of MicroRNAs in Cardiac Disease with Stroke in Pregnancy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:5260085. [PMID: 36132229 PMCID: PMC9484966 DOI: 10.1155/2022/5260085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022]
Abstract
Pregnancy-related cardiovascular disease with stroke remains a considerable source of higher maternal morbidity and mortality occurs in periods of pregnancy, delivery, and postpartum. It is essential to counsel the mother before pregnancy by an expert cardiologist and obstetric team to discuss any event related to preexistent cardiac or past preeclampsia for estimation of maternal and fetal risks. In pregnancy, the cardiac state includes hypertensive disorders, ischemic heart disease, valvular disease, and postpartum stroke. The incidence of stroke is increasing in pregnancy, particularly in postpartum, and its strong relationship with hypertensive disorders of pregnancy (preeclampsia). The combined cardiologist and obstetrics team requires during pregnancy mainly due to the approach to the management of a cardiac disease that subsequently prevents stroke postpartum. Therefore, a general perception of cardiac disease during pregnancy, delivery, and postpartum should be a core knowledge extent for all cardiovascular and clinicians. Many studies provided linked that deregulation of microRNAs (miRNAs) in maternal circulation and placenta tissue may development of pregnancy complications including preeclampsia considered a diagnostic marker. The desire of this review provides a detailed outline of current knowledge and dealing in this field with strength on the physiological changes during pregnancy.
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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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Carlier L, Devroe S, Budts W, Van Calsteren K, Rega F, Van de Velde M, Rex S. Cardiac interventions in pregnancy and peripartum – a narrative review of the literature. J Cardiothorac Vasc Anesth 2020; 34:3409-3419. [DOI: 10.1053/j.jvca.2019.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/19/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022]
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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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Cesaro A, Bravo IG, Calabrò P, Bermudez EP. Rheumatic mitral stenosis in a 28-week pregnant woman treated by mitral valvuoplasty guided by low dose of radiation: a case report and brief overview. Gen Thorac Cardiovasc Surg 2020; 69:364-366. [PMID: 32852694 DOI: 10.1007/s11748-020-01465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
Rheumatic mitral stenosis is still a pathological condition that affects young patients and is an important cause of mortality. 2017-European Guidelines for the management of valvular heart disease suggest a percutaneous approach with a mitral commissurotomy for the treatment of symptomatic pregnant women. Mitral commissurotomy procedure involves radiation exposure that is incompatible with the pregnancy condition. In our case, we present percutaneous mitral commissurotomy (PMC) to a 28-week pregnant woman with a low-radiation dose and the use of transesophageal echocardiography. The woman presented with a mitral transvalvular mean gradient of 21.6 mmHg and with symptoms non-responsive to medical treatment. PMC was driven by a transesophageal echocardiographic probe. This case demonstrates the feasibility and safety of PMC in a pregnant woman with severe rheumatic mitral stenosis.
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Affiliation(s)
- Arturo Cesaro
- Division of Cardiology, Hospital Universitario Vìrgen de La Arrixaca, Murcia, Spain
- Division of Cardiology, Department of Medical Translational Science, AORN S.Anna e San Sebastiano, Caserta, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Iris Garrido Bravo
- Division of Cardiology, Hospital Universitario Vìrgen de La Arrixaca, Murcia, Spain
| | - Paolo Calabrò
- Division of Cardiology, Department of Medical Translational Science, AORN S.Anna e San Sebastiano, Caserta, University of Campania "Luigi Vanvitelli", Naples, Italy
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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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Vinayakumar D, Vinod GV, Madhavan S, Krishnan MN. Maternal and fetal outcomes in pregnant women undergoing balloon mitral valvotomy for rheumatic mitral stenosis. Indian Heart J 2016; 68:780-782. [PMID: 27931546 PMCID: PMC5143819 DOI: 10.1016/j.ihj.2016.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background Rheumatic mitral stenosis constitutes a major cause of acquired heart disease complicating pregnancy in India. In the present study, we have studied the fetal and maternal outcomes of women undergoing balloon mitral valvotomy during pregnancy. Methods and results 49 pregnant ladies were included in this study in whom balloon mitral valvotomy was performed. The mean age of these patients was 25.7 ± 3.1 years. The mean gestational age was 23.5 ± 5.2 weeks (12–36 weeks). The procedure was successful in 48 patients (95.9%). Mean two-dimensional MVA increased from baseline value of 0.93 ± 0.17 cm2 to 1.75 ± 0.27 cm2 (p value <0.0001). Pre-procedure peak pulmonary artery pressure was 43.05 ± 15.88 mmHg, which decreased to 22.31 ± 6.36 mmHg (p value <0.0001). Hemodynamic data showed pre-BMV left atrial mean pressure of 29.6 ± 6.6 mmHg, which decreased to 13.7 ± 4.8 mmHg after the procedure (p value <0.0001). Mean fluoroscopy time was 6.4 ± 1.2 min. There was no maternal mortality in our study. One procedure had to be abandoned, because of failed septal puncture. One of the patients developed cardiac tamponade and another patient developed severe mitral regurgitation, which were managed medically. The patient who developed severe mitral regurgitation later underwent mitral valve replacement. Post-procedure follow-up showed an improvement in NYHA status by at least one class in 81.3% of patients. Thirty-nine (81.3%) patients had a term normal vaginal delivery and 8 (16.7%) underwent cesarean section for obstetric indications. One of the patients had abortion on the second day of the procedure. Conclusion Percutaneous mitral valvotomy during pregnancy is safe and provides excellent symptomatic relief and hemodynamic improvement. This should be considered as the treatment of choice when managing pregnant women with severe mitral stenosis.
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Affiliation(s)
| | - G V Vinod
- Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
| | - Suresh Madhavan
- Department of Cardiology, Government Medical College, Kottayam, Kerala, India
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Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr 2016; 27:111-8. [PMID: 27213859 PMCID: PMC4928166 DOI: 10.5830/cvja-2016-052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/14/2016] [Indexed: 11/29/2022] Open
Abstract
Valvular heart disease may be a pre-existing complication of pregnancy or it may be diagnosed for the first time during pregnancy. Accurate diagnosis, tailored therapy and an understanding of the physiology and pathophysiology of pregnancy are necessary components of management, best achieved through the use of multidisciplinary clinics. This review outlines the management of specific lesions, with particular reference to post-rheumatic valvular heart disease.
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Affiliation(s)
- John Anthony
- Division of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Ayesha Osman
- Division of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mahmoud U Sani
- Department of Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kanu, Nigeria
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Monagle J, Manikappa S, Ingram B, Malkoutzis V. Pulmonary hypertension and pregnancy: the experience of a tertiary institution over 15 years. Ann Card Anaesth 2016; 18:153-60. [PMID: 25849682 PMCID: PMC4881648 DOI: 10.4103/0971-9784.154466] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Pulmonary hypertension (PH) in pregnancy is associated with a high maternal mortality and morbidity and has been found to be as high as 30-56%. Aim: To review the management of such patients in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small case series and 2 meta-analyses. Materials and Methods: A review of all patients admitted to our institution for management of PH in pregnancy between 1994 and February 2009 was undertaken. Cases were identified from the high-risk pregnancy database within the department of anesthesia and from the hospital medical records. Severity of PH, type of PH, NYHA functional status at presentation and delivery, mode of delivery, peripartum monitoring and APGAR scores were noted. Patients were reviewed by a multidisciplinary team and management planned accordingly. Results: 19 eligible patients were identified. Patients who were significantly sick due to their PH were aggressively managed during pregnancy. Overall there was an improvement in NYHA functional status at the time of delivery. Epidural analgesia and anesthesia for labor and operatively delivery seem to be the ideal choice. Conclusion: Multidisciplinary approach is a key to the successful management of these patients. Secondary PH results in higher morbidity and mortality, in particular, older the age higher the maternal morbidity and mortality.
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Affiliation(s)
| | - Shashikanth Manikappa
- Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Clayton, Victoria 3168, Australia
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Joshi HS, Deshmukh JK, Prajapati JS, Sahoo SS, Vyas PM, Patel IV. Study of Effectiveness and Safety of Percutaneous Balloon Mitral Valvulotomy for Treatment of Pregnant Patients with Severe Mitral Stenosis. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2015; 9:OC14-7. [PMID: 26816932 DOI: 10.7860/jcdr/2015/14765.6923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In pregnant women mitral stenosis is the commonest cardiac valvular lesion. When it is present in majorly severe condition it leads to maternal and fetal morbidity and mortality. In mitral stenosis pregnancy can lead to development of heart failure. AIM To evaluate the safety and efficacy of balloon mitral valvulotomy (BMV) in pregnant females with severe mitral stenosis. MATERIALS AND METHODS A total of 30 pregnant patients who underwent BMV were included in the study from July 2011 to November 2013. Clinical follow-up during pregnancy was done every 3 months until delivery and after delivery. The mean follow up time after BMV was 6.72±0.56 months. RESULTS From the 30 pregnant females 14 (46.67%) and 16 (53.3%) patients underwent BMV during the third and second trimester of pregnancy respectively. The mean mitral valve area was 0.85+0.16 cm(2) before BMV that increased to 1.60+0.27 cm(2) (p<0.0001) immediately after BMV. Peak and mean diastolic gradients had decreased significantly within 48 hours after the procedure (p<0.001) but remained very much unchanged at 6.72 month period of follow-up. Two patients had an increase in mitral regurgitation by 2 grades. CONCLUSION During pregnancy BMV technique is safe and effective in patients with severe mitral stenosis. This results in marked symptomatic relief along with long term maternal and fetal outcomes.
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Affiliation(s)
- Hasit Sureshbhai Joshi
- Associate Professor, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Jagjeet Kishanrao Deshmukh
- Associate Professor, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Jayesh Somabhai Prajapati
- Head of Department, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Sibasis Shahsikant Sahoo
- Associate Professor, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Pooja Maheshbhai Vyas
- DM Resident, Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
| | - Iva Vipul Patel
- Research Fellow, Department of Research, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Ahmedabad, India
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Kapoor D, Choudhary F, Smith WHT, Wallace S. Percutaneous mitral commisurotomy during pregnancy - A report of two cases performed in a United Kingdom tertiary centre and a review of the literature. Obstet Med 2015; 8:195-9. [PMID: 27512481 PMCID: PMC4935054 DOI: 10.1177/1753495x15600571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/12/2015] [Indexed: 11/15/2022] Open
Abstract
We report two cases of severe mitral stenosis where percutaneous mitral commisurotomy was performed within pregnancy. The first case involves an emergency procedure for a new diagnosis of severe mitral stenosis in a woman presenting with pulmonary oedema at 27 weeks' gestation. The second case is of a woman known to have mitral stenosis who underwent a semi-elective procedure for deterioration in symptoms. This procedure is not commonly performed in the United Kingdom because of low incidence of rheumatic heart disease. In addition, percutaneous mitral commisurotomy during pregnancy is rarely performed in the United Kingdom because of the improved healthcare system where majority of the women with moderate to severe mitral stenosis (even asymptomatic) will undergo planned interventions (percutaneous mitral commisurotomy or mitral valve surgery) before contemplating pregnancy. These cases highlight both the acute and chronic presentations of mitral stenosis and the impact pregnancy has on this condition. In addition, these cases show the importance of retaining skills in performing percutaneous mitral commisurotomy within our United Kingdom cardiologists.
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Affiliation(s)
- Dipanwita Kapoor
- Department of Obstetrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ferrah Choudhary
- Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - William HT Smith
- Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Suzanne Wallace
- Department of Obstetrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Windram JD, Colman JM, Wald RM, Udell JA, Siu SC, Silversides CK. Valvular heart disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2014; 28:507-18. [DOI: 10.1016/j.bpobgyn.2014.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/13/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
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Sartain JB, Anderson NL, Barry JJ, Boyd PT, Howat PW. Rheumatic heart disease in pregnancy: cardiac and obstetric outcomes. Intern Med J 2014; 42:978-84. [PMID: 22288941 DOI: 10.1111/j.1445-5994.2012.02725.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains an important health issue for indigenous women of child-bearing age in northern Australia. However, the influence of RHD on maternal outcomes with current clinical practice is unclear. AIMS To determine maternal cardiac complications and obstetric outcomes in patients with RHD. METHODS Retrospective case note analysis of women with RHD who received obstetric care between July 1999 and May 2010 at Cairns Base Hospital in north Queensland. Outcome measures were obstetric interventions and outcomes, cardiac interventions and complications, stratified according to a cardiac risk score (CRS). RESULTS Ninety-five confinements occurred in 54 patients, of whom 52 were Indigenous Australians. There were no maternal or neonatal deaths. With a CRS of 0, cardiac complications occurred in 0 of 70 confinements; with a CRS of 1, complications occurred in 5 of 17 confinements (29%); with a CRS of >1, complications occurred in 2 of 4 confinements (50%). Another four patients were first diagnosed with RHD after developing acute pulmonary oedema during the peripartum period. CONCLUSIONS RHD has a major impact on maternal cardiac outcomes. However, with current management practices, maternal and fetal mortality are low, and the incidence of complications is predictable based on known risk factors.
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A G, W K, Fa N, Me F. Mitral balloon valvuloplasty during pregnancy:The long term up to 17 years obstetric outcome and childhood development. Pak J Med Sci 2014; 30:86-90. [PMID: 24639837 PMCID: PMC3955548 DOI: 10.12669/pjms.301.4305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/30/2013] [Accepted: 12/02/2013] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED Background & Objectives : We report 17 years outcome of subsequent pregnancies of women with severe Mitral Stenosis (MS) who underwent Mitral Balloon Valvuloplasty (MBV) during pregnancy and the follow up of the children born of such pregnancies. METHODS Twenty three pregnant patients suffering from severe MS (NYHA-New York Heart Association class III/IV) who underwent MBV by Inoue balloon catheter technique during second trimester were enrolled. The study was performed between January 1992 and December 2008 at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, during which time, details about the obstetric outcome and childhood development were recorded. Mean follow up period was 10± 5.5 years (range 1-17 years). RESULTS MBV was successful in all patients with improvement in their NYHA class to I/II. All patients were followed until term and had uneventful course after MBV. Twenty two (95.6%) patients delivered 23 babies including a twin birth. These children exhibited normal growth and development according to their age. Nineteen patients had further pregnancies and gave birth to 38 live & healthy babies with one still birth and no unfavorable maternal outcome. Of these, 97.4% were singleton pregnancies while 2.6% were twin pregnancies. Spontaneous abortions were recorded in 21.5% and there was one still birth (2.5%) and one ectopic pregnancy (2.5%). Conclusion : Mitral Balloon Valvuloplasty is a safe and useful procedure during pregnancy, with no short or long term adverse affects on the mothers and their obstetric future. The children born of subsequent pregnancies exhibited normal physical and mental development.
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Affiliation(s)
- Gulraze A
- Gulraze A, MRCOG, Perinatology Section, Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Kurdi W
- Kurdi W, MD, Perinatology Section, Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Niaz Fa
- Niaz FA, MRCP, Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Fawzy Me
- Fawzy ME, FRCP, Formerly Cardiologist, Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Henriquez DD, Roos-Hesselink JW, Schalij MJ, Klautz RJ, Helmerhorst FM, de Groot CJ. Treatment of valvular heart disease during pregnancy for improving maternal and neonatal outcome. Cochrane Database Syst Rev 2011:CD008128. [PMID: 21563164 DOI: 10.1002/14651858.cd008128.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Valvular heart disease constitutes the majority of all causes of heart disease in pregnancy. In the presence of valvular heart disease, the necessary haemodynamic changes of pregnancy might cause heart failure, leading to severe maternal and fetal morbidity and even mortality. Treatment of valvular heart disease is indicated when patients experience a deterioration of symptoms and in case of a severe valvular lesion. Whether medical therapy or interventional therapy is the optimal treatment for both mother and child is unclear. OBJECTIVES To assess effectiveness and adverse effects of the different treatment modalities of valvular heart disease in pregnancy to improve maternal and neonatal outcomes. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), EMBASE (1980 to 23 March 2011) and the reference lists of background review articles. SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled and cluster-randomised controlled trials comparing medical therapy with percutaneous or surgical intervention for the treatment of valvular heart disease in pregnancy. DATA COLLECTION AND ANALYSIS We identified no (randomised) controlled trials to assess the effectiveness and adverse effects of the treatment of valvular heart disease in pregnancy. MAIN RESULTS There were no randomised controlled trials, quasi-randomised controlled trials or cluster-randomised trials identified from the search strategy. AUTHORS' CONCLUSIONS There is insufficient evidence to define the most effective treatment of valvular heart disease in pregnancy to improve maternal and neonatal outcomes.
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Affiliation(s)
- Dacia Dca Henriquez
- Department of Gynaecology, Medical Centre Haaglanden, Lijnbaan 32, The Hague, Netherlands
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Abstract
Mitral stenosis is one of the more commonly seen valve lesions encountered in pregnancy. The pathophysiologic implications, management strategies, and a comprehensive review of literature over the past 20 years for optimal timing of catheter balloon commissurotomy during pregnancy are discussed. Mechanical relief of obstruction is indicated for cases of severe symptomatic mitral stenosis in pregnancy refractory to medical therapy. Catheter balloon commissurotomy is the procedure of choice in a select group of these patients with suitable valve morphology.
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21
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The Diagnosis and Management of Chronic Rheumatic Heart Disease—An Australian Guideline. Heart Lung Circ 2008; 17:271-89. [DOI: 10.1016/j.hlc.2007.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 11/30/2007] [Accepted: 12/03/2007] [Indexed: 11/22/2022]
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Sakal C, Makaryus AN, Rosen SE, Jauhar S. Successful preterm delivery in a patient with severe mitral stenosis. Cardiol Rev 2006; 14:e24-6. [PMID: 17053369 DOI: 10.1097/01.crd.0000201730.45576.3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present the case of a 36-year-old woman who was diagnosed with severe mitral stenosis in the 30th week of a pregnancy that was complicated by complete placenta previa and placenta percreta. With medical management, she successfully carried the pregnancy to fetal viability and was delivered by cesarean section before undergoing percutaneous balloon mitral valvuloplasty.
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Affiliation(s)
- Christopher Sakal
- North Shore-Long Island Jewish Health System, Long Island Jewish Medical Center, New Hyde Park, New York. 11040, USA
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Abstract
Pregnancy in patients with valvular heart disease (VHD) continues to pose a challenge to both physicians and their patients and could be associated with an unfavorable maternal as well as fetal outcome. The purpose of this paper is to review the available clinical data and provide recommendations for the management of patients with VHD during gestation.
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Affiliation(s)
- Uri Elkayam
- Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California 90033, USA.
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Sivadasanpillai H, Srinivasan A, Sivasubramoniam S, Mahadevan KK, Kumar A, Titus T, Tharakan J. Long-term outcome of patients undergoing balloon mitral valvotomy in pregnancy. Am J Cardiol 2005; 95:1504-6. [PMID: 15950584 DOI: 10.1016/j.amjcard.2005.02.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 02/12/2005] [Accepted: 02/07/2005] [Indexed: 11/27/2022]
Abstract
The outcome of 36 patients (mean age 25.8 +/- 4.3 years) who underwent balloon mitral valvuloplasty during pregnancy is described in this report. The procedure was successful in 35 patients (97.2%), with no maternal mortality, and all patients subsequently had symptomatic improvement and uneventful deliveries. The children had normal growth and development at a follow up of 2.8 +/- 3.3 years. Thus, in patients with symptomatic severe mitral stenosis, balloon mitral valvuloplasty is feasible, safe, and effective with good long-term outcomes for both the mother and the fetus.
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