Percutaneous mitral commissurotomy in women with asymptomatic severe mitral stenosis before pregnancy

OBJECTIVES

Performing percutaneous mitral commissurotomy (PMC) in the women with asymptomatic severe mitral stenosis (MS) who plan a pregnancy is recommended. However the data regarding this recommendation is limited in the literature. We aimed to investigate maternal and fetal outcomes of women with asymptomatic severe MS who underwent PMC before a planned pregnancy.

METHODS

We retrospectively analysed the procedural, pregnancy related, and fetal outcomes of 33 consecutive women with severe asymptomatic MS, age 27.97 ± 2.86 years, who underwent PMC before a planned pregnancy between 2014 and 2019. The control group comprised of 66 pregnant women, age 29.09 ± 3.00 years, without a cardiac disease.

RESULTS

The PMC procedure was successful in all patients and no major complication occurred. There were no deaths, pulmonary oedema, heart failure, atrial fibrillation, and thromboembolism during pregnancy. Maternal arrhythmia (p < .001), deterioration in NYHA class (p = .08), and use of cardiovascular medication (p < .001) was significantly higher in the study group. Maternal hospitalisation (p = .435), preeclampsia (p = 1), abortus (p = 1), fetal death (p = 1), and preterm delivery (p = .746) was similar between groups. Birth weight was significantly lower in the PMC group 2890 g (229) vs 3120 g (255) <0.001, however small for gestational age newborns were similar between groups (p = .12).

CONCLUSIONS

PMC is safe in asymptomatic women with severe MS planning a future pregnancy. In selected patients with favourable valve anatomy PMC may improve maternal and fetal outcomes.

Assessment of bicuspid aortic valve phenotypes and associated pathologies: A transesophageal echocardiographic study

OBJECTIVE

We investigated the frequency of different bicuspid aortic valve disease (BAV) phenotypes,the associated valvular pathologies, and the aortopathy phenotypes, using 2-dimensional (2D) transthoracic, 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE.

METHODS

A total of 154 patients with BAV were included. Five BAV phenotypes were detected. To better define valvular pathologies, binary classifications of BAV were used: BAV with antero-posterior commisural line (BAV-AP) and right-left commissural line (BAV-RL). Aortopathy phenotype was classified according to the involved tract(s).

RESULTS

Of the patients, 53.2% had type 1, 16.2% type 2, 15.6% type 3, 1.3% type 4, and 13.6% had type 5 BAV. The prevalence of BAV-AP and BAV-RL was 68.2% and 31.8%, respectively. No difference was detected with respect to aortic regurgitation between BAV-AP and BAV-RL (p=0.9), but the BAVRL group had an increased propensity to have a stenotic aortic valve (p=0.003). The indexed aortic diameter was larger in BAV-AP cases than BAV-RL at the sinus of Valsalva (p=0.008). In patients with dilatation of the root and tubular portion, a predominance of BAV-AP versus BAV-RL was observed (85% vs 15%). A markedly low prevalence of the root phenotype (3.2%) was observed. In 90.1% of the patients, 2D TEE was sufficient to classify BAV phenotypes; further 3D imaging was needed in 9.9% of the cases.

CONCLUSION

There may be racial differences in the frequency of valvular and aortopathy phenotypes in patients with BAV. BAV phenotypes differ with respect to aortic stenosis and aortopathy phenotypes. TEE may have good diagnostic utility in differentiating BAV phenotypes.