Mitral Stenosis in Pregnancy: A Comprehensive Review of a Challenging Cardio-Obstetric Clinical Entity

Author(s): Safinaz Abdelrahman, Nooraldaem Yousif*.

Journal Name: Reviews on Recent Clinical Trials

Volume 14 , Issue 2 , 2019

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Graphical Abstract:


Abstract:

Background: Mitral stenosis is one of the most commonly encountered valvular heart diseases during pregnancy, the majority are rheumatic in origin and poorly tolerated due to cardiocirculatory changes that occur during pregnancy, labor and postpartum.

Objective: The distinctive physiological events that arise during pregnancy and labor and the influence of mitral stenosis are tackled in this article.

Methods: Through PUBMED and MEDLINE searches, we reviewed the literature of the last decade as well as the recommendations from guidelines of high-impact worldwide.

Results: Cardiac decompensation usually takes place late in pregnancy as the hemodynamic burden of pregnancy become more pronounced as well as after delivery due to an abrupt increase of preload secondary to autotransfusion and aorto-caval decompression. The maternal and fetal complications correlate with the New York Heart Association (NYHA) functional classification and the grade of mitral stenosis. Medical therapy should be tried first. If symptoms continue in spite of optimal medical therapy, invasive procedures are recommended. Several studies revealed that vaginal delivery under epidural anesthesia is endurable and of low-risk unless obstetrically contraindicated.

Conclusion: Pregnancy and mitral stenosis remain a complex entity and a well-known trigger of maternal mortality during pregnancy and peri-partum period if not managed adequately. A good appreciation and recognition of the physiology of pregnancy and its impact on the pre-existing mitral stenosis and the presence of a specialized multidisciplinary team to handle such cases significantly decrease maternal and fetal mortality and morbidity.

Keywords: Cardiac decompensation, cardio-obstetric clinical entity, mitral stenosis, postpartum, pregnancy, valvular heart diseases.

[1]
Hu H, Pasca I. Management of complex cardiac issues in the pregnant patient. Crit Care Clin 2016; 32(1): 97-107.
[2]
Viaris de Lesegno B, Nelson-Piercy C. Advances in the management of cardiovascular disease during pregnancy. Future Cardiol 2018; 14(4): 269-72.
[3]
Hemlata GoyalP, Tewari S, Chatterjee A. Anaesthetic considerations for balloon mitral valvuloplasty in pregnant patient with severe mitral stenosis: A case report and review of literature. J Clin Diagn Res JCDR 2017; 11(9): Ud01-ud3.
[4]
Peng W, Jia Y. Severe mitral stenosis in term pregnancy: Management by simultaneous cesarean section and mitral valve replacement. Case report. Clin Exp Obstet Gynecol 2017; 44(2): 277-8.
[5]
Ek M, Vladic-Stjernholm Y, Gunther A, Hallsjo-Sander C, Jacobsen PH. Rheumatic heart disease behind life-threatening heart failure in pregnancy. Lakartidningen 2016; 113: 1.
[6]
Wu W, Chen Q, Zhang L, Chen W. Epidural anesthesia for cesarean section for pregnant women with rheumatic heart disease and mitral stenosis. Arch Gynecol Obstet 2016; 294(1): 103-8.
[7]
Celik M, Dostbil A, Alici HA, et al. Anaesthetic management for caesarean section surgery in two pregnant women with severe pulmonary hypertension due to mitral valve stenosis. Balkan Med J 2013; 30(4): 439-41.
[8]
Elassy SM, Elmidany AA, Elbawab HY. Urgent cardiac surgery during pregnancy: A continuous challenge. Ann Thorac Surg 2014; 97(5): 1624-9.
[9]
Benali Zel A, Ahmaidi H, Rachidi K, Omari D. Mitral stenosis with term pregnancy: How to manage this case? Pan Afr Med J 2013; 14: 144.
[10]
Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol 2001; 37(3): 893-9.
[11]
Silversides CK, Colman JM, Sermer M, Siu SC. Cardiac risk in pregnant women with rheumatic mitral stenosis. Am J Cardiol 2003; 91(11): 1382-5.
[12]
Vaughan G, Tune K, Peek MJ, et al. Rheumatic heart disease in pregnancy: strategies and lessons learnt implementing a population-based study in Australia. Int Health 2018; 10(6): 480-9.
[13]
Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104: 515-21.
[14]
Jasper R, Skelding K. Cardiovascular disease risk unmasked by pregnancy complications. Eur J Intern Med 2018; 57: 1-6.
[15]
Swan L, Lupton M, Anthony J, et al. Controversies in pregnancy and congenital heart disease. Congenit Heart Dis 2006; 1(1-2): 27-34.
[16]
French KA, Poppas A. Rheumatic heart disease in pregnancy: global challenges and clear opportunities. Circulation 2018; 137(8): 817-9.
[17]
van den Akker T, Bloemenkamp KWM, van Roosmalen J, Knight M. Classification of maternal deaths: Where does the chain of events start? Lancet 2017; 390(10098): 922-3.
[18]
Benatta NF, Batouche DD, Djazouli MA, et al. Management of mitral valve stenosis during pregnancy at the Oran university hospital center: About 83 cases. Ann Cardiol Angeiol 2018; 67(4): 274-9.
[19]
Russell EA, Walsh WF, Costello B, et al. Medical management of rheumatic heart disease: A systematic review of the evidence. Cardiol Rev 2018; 26(4): 187-95.
[20]
van Hagen IM, Thorne SA, Taha N, et al. Pregnancy outcomes in women with rheumatic mitral valve disease: Results from the registry of pregnancy and cardiac disease. Circulation 2018; 137(8): 806-16.
[21]
Goldstein SA, Ward CC. Congenital and acquired valvular heart disease in pregnancy. Curr Cardiol Rep 2017; 19(10): 96.
[22]
Ford AA, Wylie BJ, Waksmonski CA, Simpson LL. Maternal congenital cardiac disease: Outcomes of pregnancy in a single tertiary care center. Obstet Gynecol 2008; 112(4): 828-33.
[23]
Cross S, Bell JS, Graham WJ. What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries. Bull World Health Organ 2010; 88(2): 147-53.
[24]
Baumgartner H, Falk V, Bax JJ, et al. ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38(36): 2739-91.


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Article Details

VOLUME: 14
ISSUE: 2
Year: 2019
Page: [136 - 140]
Pages: 5
DOI: 10.2174/1574887114666190207154413
Price: $58

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