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CLINICAL STUDY: VALVE DISEASE

Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy

José A. M. de Souza, MD^*, Eulogio E. Martinez, Jr, MD^*, John A. Ambrose, MD, FACC, Claudia M. R. Alves, MD^*, Daniel Born, MD^*, Enio Buffolo, MD and Antonio C. C. Carvalho, MD^*

^* Department of Cardiology, Federal University of São Paulo, São Paulo, Brazil
Comprehensive Cardiovascular Center, Saint Vincent’s Hospital and Medical Center, New York, New York, USA
Department of Cardiovascular Surgery, Federal University of São Paulo, São Paulo, Brazil

Manuscript received December 23, 1999; revised manuscript received September 27, 2000, accepted November 3, 2000.

Reprint requests and correspondence: Dr. José Augusto Marcondes de Souza, R. Borges Logoa 564-CJ93, São Paulo, SP, Brazil 04038-001
jamarcondes{at}uol.com.br

OBJECTIVES

We sought to compare the maternal and fetal outcomes of patients with severe mitral stenosis submitted to percutaneous balloon dilation versus open mitral valve commissurotomy (MVC) during pregnancy.

BACKGROUND

Heart failure in patients with mitral stenosis complicating pregnancy is a common problem in developing countries. Since 1984, percutaneous dilation of the mitral valve using a balloon catheter has become a therapeutic alternative to open heart surgery. Although the efficacy of percutaneous mitral valve balloon dilation is well established, its results have never before been compared with the results of commissurotomy during pregnancy.

METHODS

We compared the clinical and obstetric complications in 45 women who were treated with percutaneous mitral valve balloon dilation (group I, n = 21; from 1990 to 1995) or open MVC (group II, n = 24; from 1985 to 1990) for severe heart failure due to mitral stenosis during pregnancy.

RESULTS

In our study, percutaneous balloon dilation of the mitral valve had a success rate of 95% (Gorlin formula) and 90.5% (echocardiographic "pressure half-time" method), as demonstrated by the final mitral valve area achieved. This improvement was followed by a marked decrease in the mitral valve gradient, left atrial pressure and mean pulmonary artery pressure. Patients in both groups had similar improvements in symptoms. Patients who underwent percutaneous balloon dilation had significantly fewer fetal complications, with a reduction in fetal and neonatal mortality (1 death in group I vs. 8 in group II, p = 0.025).

CONCLUSIONS

Percutaneous balloon mitral valvuloplasty is safe and effective and appears to be preferable for the fetus, compared with open MVC during pregnancy.

Abbreviations and Acronyms   MVC = mitral valve commissurotomy   PBMV = percutaneous balloon mitral valvuloplasty

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