Document Detail

Mitral stenosis in pregnancy: a four-year experience at King Edward VIII Hospital, Durban, South Africa.
MedLine Citation:
PMID:  10955424     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate prospectively mitral stenosis in pregnancy with emphasis on women with persistent symptoms.
SETTING: King Edward VIII Hospital, a tertiary referral obstetric unit.
PARTICIPANTS: One hundred and twenty-eight consecutive women with mitral stenosis.
DEMOGRAPHICS: The mean age was 27 years and 38 women (30%) were primigravidae. Seventy-eight (61%) women had their first cardiac evaluation in the third trimester. Fifty-four women (42%) of these women had mitral stenosis diagnosed for the first time in the index pregnancy. Twenty-nine (23%) had a previous mitral valvulotomy. Nineteen women (15%) developed hypertension during pregnancy, 10 of whom had pre-eclampsia. Sixty-three women (49%) had a mitral valve area of < or = 1.2 cm2 with 11 having critical mitral stenosis (mitral valve area < or = 0.8 cm2). Atrial fibrillation was present in 12 women. Most women (87%) required medical therapy to control the heart rate. OUTCOME IN PERSISTENT SYMPTOMATIC WOMEN: Intervention was considered in 37 women (29%) who remained symptomatic, 11 (9%) of whom had a calcified mitral valve. The remaining 26 women were scheduled for balloon mitral valvulotomy during pregnancy, 20 of whom had balloon mitral valvulotomy with good effect (16 antepartum; 4 postpartum). In seven women, scheduled balloon mitral valvulotomy was not performed because of advanced preterm labour (n = 5), fetal distress (n = 1) and preterm labour with fetal distress (n = 1). These seven, together with the 11 with calcific mitral stenosis, were managed conservatively with good outcome. MATERNAL COMPLICATIONS: Fifty-one percent had maternal complications, the majority occurring at their initial admission to hospital. Pulmonary oedema was the most frequent. Multiple logistic regression analysis showed that the severity of stenosis assessed by measurement of the mitral valve area by echo-Doppler was the most powerful predictor of maternal pulmonary oedema. The other factors were late antenatal presentation, presence of symptoms prior to the index pregnancy and diagnosis of cardiac disease for the first time in the index pregnancy.
CONCLUSION: Despite serious disease, women with persistent symptoms treated either by balloon mitral valvulotomy where feasible, or conservatively with close noninvasive monitoring, had a satisfactory fetal and maternal outcome.
D K Desai; M Adanlawo; D P Naidoo; J Moodley; I Kleinschmidt
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  107     ISSN:  1470-0328     ISO Abbreviation:  BJOG     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2000-09-11     Completed Date:  2000-09-11     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  953-8     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynaecology, University of Natal Medical School, Durban, South Africa.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Catheterization / methods*
Echocardiography, Doppler
Heart Rate / physiology
Mitral Valve Stenosis / diagnosis*,  therapy
Pregnancy Complications, Cardiovascular / diagnosis*,  therapy
Prospective Studies
South Africa / epidemiology
Treatment Outcome
Reg. No./Substance:
0/Adrenergic beta-Antagonists

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