Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis

Pregnancy Complicated by Severe Bioprosthetic Mitral Valve Stenosis Treated by Valve-in-Valve Transcatheter Mitral Valve Replacement

The number of women with cardiac disease achieving pregnancy has increased and continues to rise. Traditional surgical cardiac interventions carry a high risk of morbidity and mortality for both mother and fetus during pregnancy. Transcatheter valve replacement is reserved for high-risk surgical candidates, but not widely used during pregnancy. Only 3 prior cases have been reported in which a transcatheter mitral valve replacement was done during pregnancy, all of which were performed before fetal viability. This paper presents the first reported case of a patient who had severe bioprosthetic mitral valve stenosis who underwent transcatheter mitral valve replacement via a valve-in-valve approach at 25 weeks' gestation with good maternal and fetal outcome. Transcatheter mitral valve replacement via a valve-in-valve approach may be a safer and effective alternative to surgical replacement when termination of pregnancy is not sought for severe bioprosthetic mitral valve stenosis.

Mitral Transcatheter Edge-to-Edge Repair in a Pregnant Woman: Procedure and Pregnancy Outcomes

Secondary mitral regurgitation (MR) associated with left ventricular dysfunction carries a high risk of acute heart failure during pregnancy because of associated hemodynamic changes. Mitral transcatheter edge-to-edge repair (TEER) is currently recommended for symptomatic patients with secondary MR; however, no evidence exists on the use of this therapy in pregnancy. We present a case of secondary MR in a pregnant woman with dilated cardiomyopathy. She was successfully treated with TEER with minimal use of fluoroscopy (35 seconds). This is the first case to our knowledge of mitral TEER during pregnancy described in the literature, suggesting feasibility and safety of this procedure.

Heart disease in pregnancy and adverse outcomes: an umbrella review

Background

Heart disease in pregnancy encompasses both congenital heart disease and maternal-acquired heart disease, both of which are associated with an increased risk of various adverse outcomes for mothers and their offspring.

Objective

The objective of the study was to review and summarize the evidence regarding the association between heart disease in pregnancy and adverse outcomes in mothers and their offspring.

Data sources

A comprehensive search was conducted in Embase, PubMed, Web of Science, and the Cochrane Database of Systematic Reviews from inception to March 2024. The protocol for this review was registered in PROSPERO (CRD42024519144).

Study eligibility criteria

This review included systematic reviews and meta-analyses that examined the association between heart disease in pregnancy and adverse outcomes for mothers and their offspring.

Study appraisal and synthesis methods

Data were independently extracted by two reviewers. The quality of the systematic reviews and meta-analyses was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2), while Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the strength of the evidence for each outcome.

Results

A total of 12 meta-analyses and systematic reviews were included, which documented 156 adverse outcomes for mothers and 65 adverse outcomes for offspring. Evidence was found for both primary and secondary adverse outcomes. Adverse outcomes for mothers were death, cardiac events (cardiac arrest, heart failure, surgery, arrhythmia, anesthesia or sedation, endocarditis, mitral regurgitation, myocardial infarction, NYHA III-IV, restenosis, syncope, and others), pulmonary events (respiratory failure, pulmonary edema, and respiratory support), embolism, cerebrovascular events, postpartum hemorrhage, arterial events, delivery mode, and hospital stay. Adverse outcomes for offspring were death, pregnancy loss, growth restriction, low birth weight, preterm birth, recurrence, and uncertainty. No publication bias was detected using Egger's test. The overall AMSTAR 2 confidence rating for the included meta-analyses and systematic reviews was moderate. The majority (55.3%) of the evidence evaluated by GRADE was of low quality, while the remaining outcomes were categorized as having "very low"-quality evidence.

Conclusion

Current evidence links heart disease during pregnancy to adverse maternal outcomes, including death and cardiac, pulmonary, and cerebrovascular events, as well as increased mortality risk for offspring. Many meta-analyses in this field have limitations that raise concerns about their validity, highlighting the need for high-quality prospective studies.

First Percutaneous Balloon Mitral Valvuloplasty in a Pregnant Patient in Tanzania

Percutaneous balloon mitral valvuloplasty (PBMV) is a safe alternative to management of a pregnant woman with mitral stenosis. We report the first successful PBMV in a 27-year-old pregnant patient in Tanzania at 32 weeks gestation with NYHA functional class III symptoms. PBMV yielded excellent results.

Severe Rheumatic Mitral Stenosis During Pregnancy

A 28-year-old woman, gravida 2 para 1, with previously unknown severe rheumatic mitral stenosis presented with progressive dyspnea at 26 weeks of gestation. Percutaneous commissurotomy was considered but was deferred after symptom improvement with beta-blockers and diuretics. Pregnancy complications ensued, requiring preterm delivery. Postpartum percutaneous commissurotomy was successful, highlighting the complexities in managing rheumatic heart disease during pregnancy.

The male-to-female ratio in late-onset multiple acyl-CoA dehydrogenase deficiency: a systematic review and meta-analysis

BACKGROUND

Late-onset multiple acyl-CoA dehydrogenase deficiency (MADD) is the most common lipid storage myopathy. There are sex differences in fat metabolism and it is not known whether late-onset MADD affects men and women equally.

METHODS

In this systematic review and meta-analysis, the PubMed, Embase, Web of Science, CNKI, CBM, and Wanfang databases were searched until 01/08/2023. Studies reporting sex distribution in patients with late-onset MADD were included. Two authors independently screened studies for eligibility, extracted data, and assessed risk of bias. Pre-specified outcomes of interest were the male-to-female ratio (MFR) of patients with late-onset MADD, the differences of clinical characteristics between the sexes, and factors influencing the MFR.

RESULTS

Of 3379 identified studies, 34 met inclusion criteria, yielding a total of 609 late-onset MADD patients. The overall pooled percentage of males was 58% (95% CI, 54-63%) with low heterogeneity across studies (I2 = 2.99%; P = 0.42). The mean onset ages, diagnostic delay, serum creatine kinase (CK), and allelic frequencies of 3 hotspot variants in ETFDH gene were similar between male and female patients (P > 0.05). Meta-regressions revealed that ethnic group was associated with the MFR in late-onset MADD, and subgroup meta-analyses demonstrated that East-Asian patients had a higher percentage of male, lower CK, and higher proportion of hotspot variants in ETFDH gene than non-East-Asian patients (P < 0.05).

CONCLUSIONS

Male patients with late-onset MADD were more common than female patients. Ethnicity was proved to be a factor influencing the MFR in late-onset MADD. These findings suggest that male sex may be a risk factor for the disease.

Childbearing Performances and Outcomes of Female Patients with Rheumatic Mitral Valve Diseases after Different Mitral Interventions

PURPOSE

This study aimed to illustrate how percutaneous balloon mitral valvuloplasty (PBMV) and mitral valve (MV) surgeries influence women of childbearing age with rheumatic mitral valve diseases (RMVDs) from two aspects, including clinical outcomes and their postoperative childbearing performances.

METHODS

Female patients with RMVD who were of childbearing age and underwent MV interventions between 2007 and 2019 at Beijing Anzhen Hospital were identified. Outcomes included all-cause deaths, repeated MV interventions, and atrial fibrillation. A survey about childbearing attempts and complications during pregnancy was also performed during follow-up.

RESULTS

A total of 379 patients were involved in this study, consisting of 226 cases of mitral valve replacements, 107 cases of mitral valve repairs (MVrs), and 46 cases of PBMVs. PBMV was associated with higher possibilities of repeated MV interventions (P <0.05). Postoperative childbearing attempts were more frequently observed among bioprosthesis, MVr, and PBMV (P <0.05). However, PBMV and MVr showed a higher incidence of cardiac complications during pregnancy as compared to prosthesis replacement (P <0.05).

CONCLUSIONS

MVr and PBMV are not recommended to young female patients for higher incidences of postoperative complications. Safe pregnancy is more likely to be present among patients with biological prosthesis.

Rheumatic Heart Disease: JACC Focus Seminar 2/4

It is a sad reality that although eminently preventable, and despite possessing such knowledge for >70 years, rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and early mortality in young people worldwide. A disease of the poor, RHD is one of the most neglected diseases. Several challenges are unique to the acute rheumatic fever/RHD continuum and contribute to its persistence, including its sequestration among the poorest, its protracted natural history, the erratic availability of penicillin, and the lack of a concerted effort in endemic regions. However, there is cause for optimism following a resurgence in scientific interest over the last 15 years. This review presents the latest advancements in epidemiology, diagnosis, and management. It also discusses pressing research questions on disease pathophysiology, the barriers to implementation of effective management strategies, and pragmatic policy solutions required for translation of current knowledge into meaningful action.