Clinical efficacy of percutaneous balloon mitral valvuloplasty under echocardiographic guidance for moderate to severe mitral stenosis during pregnancy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEI Peijian ^1,2 , LI Wenchao ^1,2 , LI Hang ^1,2 , FANG Fang ^1,2 , ZHANG Fengwen ^1,2 , OUYANG Wenbin ^1,2 , LI Shiguo ^1,2 ,  ZHANG Deyuan ³ , LIN Yixian ⁴ , PAN Xiangbin ^1,2

1. Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P. R. China;
2. National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, National Clinical Research Center for Cardiovascular Diseases, Beijing, 100037, P. R. China;
3. Life Tech Scientific Company, Shenzhen, 518057, Guangdong, P. R. China;
4. Hong Kong Canossa Hospital, Asia Heart Center, Hongkong, 999077, P. R. China;

Corresponding author：

ZHANG Deyuan, Email: panxiangbin@fuwaihospital.org

Keywords：

Pregnancy; mitral stenosis; percutaneous balloon mitral valvuloplasty; echocardiography-guided intervention

DOI：

10.7507/1007-4848.202302006

Video：

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Objective To investigate the effect of percutaneous balloon mitral valvuloplasty under echocardiographic guidance for patients with moderate to severe mitral stenosis during pregnancy. Methods A retrospective observational study was conducted to include pregnant women who were diagnosed with moderate to severe mitral stenosis and underwent percutaneous balloon mitral valvuloplasty under echocardiographic guidance in Fuwai Hospital from August 2018 to June 2022, and their baseline characteristics, surgical outcomes, echocardiographic results, and follow-up results were analyzed. Results A total of 3 pregnant women aged 30-35 years, with gestational age of 19-26 weeks, and New York Heart Association (NYHA) function class Ⅲ were included. All the procedures were successfully performed. The mitral valve orifice area increased from 0.9 cm² preoperatively to 2.1 cm² postoperatively. The mean transvalvular pressure gradient decreased from 15.0 mm Hg preoperatively to 6.7 mm Hg postoperatively. No perioperative adverse events occurred. The follow-up time ranged from 3 to 48 months. All patients delivered uneventfully and returned to normal life, with maternal-fetal safety. Conclusion Percutaneous balloon mitral valvuloplasty under echocardiographic guidance is a feasible and effective procedure for the treatment of patients with moderate to severe mitral stenosis in pregnancy, with satisfactory maternal-fetal outcomes.

Citation： WEI Peijian, LI Wenchao, LI Hang, FANG Fang, ZHANG Fengwen, OUYANG Wenbin, LI Shiguo, ZHANG Deyuan, LIN Yixian, PAN Xiangbin. Clinical efficacy of percutaneous balloon mitral valvuloplasty under echocardiographic guidance for moderate to severe mitral stenosis during pregnancy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(9): 1333-1337. doi: 10.7507/1007-4848.202302006 Copy

1.	Gupta R, Malik AH, Ranchal P, et al. Valvular heart disease in pregnancy: Anticoagulation and the role of percutaneous treatment. Curr Probl Cardiol, 2021, 46(3): 100679.
2.	Elkayam U, Goland S, Pieper PG, et al. High-risk cardiac disease in pregnancy: Part Ⅰ. J Am Coll Cardiol, 2016, 68(4): 396-410.
3.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
4.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
5.	Sreerama D, Surana M, Moolchandani K, et al. Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand, 2021, 100(4): 666-675.
6.	Chatterjee K, Khanna R, Sahu A, et al. Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy. Indian Heart J, 2020, 72(4): 248-251.
7.	杨冬, 张伟静, 张军, 等. 妊娠期经皮二尖瓣球囊扩张术治疗中重度二尖瓣狭窄临床观察. 中华实用诊断与治疗杂志, 2017, 31(2): 151-152.Yang D, Zhang WJ, Zhang J, et al. Percutaneous balloon mitral valvuloplasty on pregnant women with moderate or severe mitral stenosis. J Chin Pract Diag Ther, 2017, 31(2): 151-152.
8.	王惠, 韩凤珍, 吴淑燕. 妊娠期经皮二尖瓣球囊扩张术的疗效分析. 岭南心血管病杂志, 2022, 28(5): 427-430, 443.Wang H, Han FZ, Wu SY. Clinical analysis of percutaneous balloon mitral valvuloplasty in pregnancy. South Chin J Cardiovasc Dis, 2022, 28(5): 427-430, 443.
9.	国家卫生健康委员会国家心外介入质控专家组, 国家心血管病中心医疗质量控制中心心外介入专家组. 单纯超声心动图引导经皮介入技术中国专家共识. 中国循环杂志, 2018, 33(10): 943-952.National Health Commission National Extracardiac Intervention Quality Control Expert Group, National Cardiovascular Disease Center Medical Quality Control Center Extracardiac Intervention Expert Group. Consensus among Chinese experts on percutaneous intervention technology guided by simple echocardiography. Chin Circ J, 2018, 33(10): 943-952.
10.	Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018, 39(34): 3165-3241.
11.	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): 806-816.
12.	Turi ZG. The 40th anniversary of percutaneous balloon valvuloplasty for mitral stenosis: Current status. Struct Heart, 2022, 6(5): 100087.
13.	Fawzy ME, Fadel B, Al-Sergani H, et al. Long-term results (up to 16.5 years) of mitral balloon valvuloplasty in a series of 518 patients and predictors of long-term outcome. J Interv Cardiol, 2007, 20(1): 66-72.
14.	Ananthakrishna Pillai A, Ramasamy C, V SG, et al. Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure. J Interv Cardiol, 2018, 31(4): 525-531.
15.	Elkayam U, Bansal P, Mehra A. Catheter-based interventions for the management of valvular heart disease during pregnancy. JACC: Adv, 2022, 1(2): 100022.
16.	Damilakis J, Theocharopoulos N, Perisinakis K, et al. Conceptus radiation dose and risk from cardiac catheter ablation procedures. Circulation, 2001, 104(8): 893-897.
17.	Mahesh M. Fluoroscopy: Patient radiation exposure issues. Radiographics, 2001, 21(4): 1033-1045.
18.	Vijayvergiya R, Suri V, Sikka P, et al. Maternal and fetal outcomes following percutaneous transluminal mitral commissurotomy in pregnant women with critical mitral stenosis: An experience of a tertiary care center from Northern India. Anatol J Cardiol, 2022, 26(7): 552-558.
19.	赵扬玉, 原鹏波, 陈练. 二孩时代高龄产妇面临的问题. 中国实用妇科与产科杂志, 2020, 36(2): 97-100.Zhao YY, Yuan PB, Chen L. Problems facing the advanced maternal age at the two-child times. Chin J Pract Gynaecol Obstet, 2020, 36(2): 97-100.

1. Gupta R, Malik AH, Ranchal P, et al. Valvular heart disease in pregnancy: Anticoagulation and the role of percutaneous treatment. Curr Probl Cardiol, 2021, 46(3): 100679.
2. Elkayam U, Goland S, Pieper PG, et al. High-risk cardiac disease in pregnancy: Part Ⅰ. J Am Coll Cardiol, 2016, 68(4): 396-410.
3. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
4. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
5. Sreerama D, Surana M, Moolchandani K, et al. Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand, 2021, 100(4): 666-675.
6. Chatterjee K, Khanna R, Sahu A, et al. Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy. Indian Heart J, 2020, 72(4): 248-251.
7. 杨冬, 张伟静, 张军, 等. 妊娠期经皮二尖瓣球囊扩张术治疗中重度二尖瓣狭窄临床观察. 中华实用诊断与治疗杂志, 2017, 31(2): 151-152.Yang D, Zhang WJ, Zhang J, et al. Percutaneous balloon mitral valvuloplasty on pregnant women with moderate or severe mitral stenosis. J Chin Pract Diag Ther, 2017, 31(2): 151-152.
8. 王惠, 韩凤珍, 吴淑燕. 妊娠期经皮二尖瓣球囊扩张术的疗效分析. 岭南心血管病杂志, 2022, 28(5): 427-430, 443.Wang H, Han FZ, Wu SY. Clinical analysis of percutaneous balloon mitral valvuloplasty in pregnancy. South Chin J Cardiovasc Dis, 2022, 28(5): 427-430, 443.
9. 国家卫生健康委员会国家心外介入质控专家组, 国家心血管病中心医疗质量控制中心心外介入专家组. 单纯超声心动图引导经皮介入技术中国专家共识. 中国循环杂志, 2018, 33(10): 943-952.National Health Commission National Extracardiac Intervention Quality Control Expert Group, National Cardiovascular Disease Center Medical Quality Control Center Extracardiac Intervention Expert Group. Consensus among Chinese experts on percutaneous intervention technology guided by simple echocardiography. Chin Circ J, 2018, 33(10): 943-952.
10. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018, 39(34): 3165-3241.
11. 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): 806-816.
12. Turi ZG. The 40th anniversary of percutaneous balloon valvuloplasty for mitral stenosis: Current status. Struct Heart, 2022, 6(5): 100087.
13. Fawzy ME, Fadel B, Al-Sergani H, et al. Long-term results (up to 16.5 years) of mitral balloon valvuloplasty in a series of 518 patients and predictors of long-term outcome. J Interv Cardiol, 2007, 20(1): 66-72.
14. Ananthakrishna Pillai A, Ramasamy C, V SG, et al. Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure. J Interv Cardiol, 2018, 31(4): 525-531.
15. Elkayam U, Bansal P, Mehra A. Catheter-based interventions for the management of valvular heart disease during pregnancy. JACC: Adv, 2022, 1(2): 100022.
16. Damilakis J, Theocharopoulos N, Perisinakis K, et al. Conceptus radiation dose and risk from cardiac catheter ablation procedures. Circulation, 2001, 104(8): 893-897.
17. Mahesh M. Fluoroscopy: Patient radiation exposure issues. Radiographics, 2001, 21(4): 1033-1045.
18. Vijayvergiya R, Suri V, Sikka P, et al. Maternal and fetal outcomes following percutaneous transluminal mitral commissurotomy in pregnant women with critical mitral stenosis: An experience of a tertiary care center from Northern India. Anatol J Cardiol, 2022, 26(7): 552-558.
19. 赵扬玉, 原鹏波, 陈练. 二孩时代高龄产妇面临的问题. 中国实用妇科与产科杂志, 2020, 36(2): 97-100.Zhao YY, Yuan PB, Chen L. Problems facing the advanced maternal age at the two-child times. Chin J Pract Gynaecol Obstet, 2020, 36(2): 97-100.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of percutaneous balloon mitral valvuloplasty under echocardiographic guidance for moderate to severe mitral stenosis during pregnancy

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