DOI: https://doi.org/10.14710/jai.v15i3.57727

Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series

1Department of Cardiology and Vascular, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, Indonesia

2Department of Obstetrics-gynecology, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, Indonesia

Received: 27 Aug 2023; Revised: 30 Nov 2023; Accepted: 30 Nov 2023; Available online: 30 Nov 2023; Published: 30 Nov 2023.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)

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Abstract

Background: Valvular heart disease in pregnancy is still not widely studied. The combination of mitral stenosis and the physiology of pregnancy for both mother and fetus often result in poor hemodynamics, and management during labor and peripartum period greatly determines the prognosis of both lives.

Case: A 42 years old G3P2A0 (Case A) and A 33 years old G3P1A1 (Case B) both had a history of previous SC labor, presented worsening shortness of breath since 2nd trimester, coughing and swelling in both legs, also unable to rest in a flat position. especially, case B was frequent re-hospitalized with prolonged LOS during 2nd – the 3rd trimester due to acute lung edema. We found a mid-diastolic murmur grade II/IV at the apex. Electrocardiography (ECG) of case A: sinus rhythm, left atrial enlargement (LAE), while case B: AF rapid response. The echocardiography of case A revealed severe MS, while case B revealed severe MS, moderate tricuspid regurgitation and, a high probability for PH. Those findings support the diagnosis of severe mitral stenosis and rheumatic heart disease in pregnancy, then they were programmed to do balloon mitral valvuloplasty (BMV) in 3rd trimester.

Discussion: The BMV was performed, and succeeded in case A reducing the mitral valve pressure gradient (MV PG) from 24.7mmHg to 12.1mmHg by using local anesthesia along the procedure, while in case B specifically done BMV with general anesthesia due to supraventricular tachycardia (SVT) and pulmonal congestive during procedure, reducing the MV PG from 17.7mmHg to 8.6mmHg, as well as improvement in symptoms, up to pregnancy was terminated as obstetric indication by SC on 36-37 weeks' gestation in both cases. The baby born was healthy with weights of each case 2340gr and 2630gr.

Conclusion: Mitral stenosis in the peripartum needs to be managed by interprofessional collaboration properly, to decrease the risk of morbidity and mortality for the mother and fetus.

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Keywords: anesthesia agent; balloon mitral valvuloplasty; mitral stenosis; peripartum; pregnancy

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Section: Case Reports
Language : EN
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  1. Youssef G. Mitral stenosis in pregnant patients escardio.org/Journals/E-Journal-of-Cardiology-Practice. 2018 Jul 25;16
  2. Van Hagen IM, Thorne SA, Taha N, Youssef G, Elnagar A, Gabriel H, El Rakshy Y, Iung B, Johnson MR, Hall R, Roos-Hesselink JW; ROPAC Investigators and EORP Team. Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease: Results From the Registry of Pregnancy and Cardiac Disease. Circulation. 2018;137:806-16. DOI: https://doi.org/10.1161/circulationaha.117.032561
  3. Yıldırım E, Çelik M, Akpak YK. Mitral Stenosis and Pregnancy. Open Sci J Clin Med. 2015 Nov 11;3:220–3
  4. Kannan M, Vijayanand G. Mitral stenosis and pregnancy: Current concepts in anaesthetic practice. Indian J Anaesth. 2010 Sep 1;54:439–44. DOI: https://doi.org/10.4103/0019-5049.71043
  5. Soma-pillay P, Nelson-piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89–94. DOI: https://doi.org/10.5830/cvja-2016-021
  6. Lindley, K; Williams D. Valvular Heart Disease in Pregnancy. JACC. 2018;1–15
  7. Nanna M, Stergiopoulos K. Pregnancy complicated by valvular heart disease: an update. J Am Heart Assoc 2014;3:e000712. DOI: https://doi.org/10.1161/jaha.113.000712
  8. Carabello BA. Mitral Stenosis. In: Fuster, V; Walsh, Richard A; Harrington RA, editor. Hurst’s the Heart. 13th ed. New York: McGraw Hill; 2011. p. 1738–42.e
  9. Vera Regitz-Zagrosek et al. ESC Guidelines for the management of cardiovascular diseases during pregnancy: The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). European Heart Journal. Volume 39:Issue 34. 07 September 2018;Pages 3165–3241. Avalaible from: https://doi.org/10.1093/eurheartj/ehy340
  10. Ituk US, Habib AS, Polin CM, et al. Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre. Can J Anaesth 2015; 62: 278–288. DOI: 10.1007/s12630-014-0290-y
  11. Chestnut DH. 4th ed. Philadelphia: Mosby Elsevier. Obstetric anesthesia: Principles and practice; 2009
  12. Alagandala A, Vaswani D, et al. Maternal Outcome in Mitral Valve Disease with Pulmonary Hypertension: Two Case Reports. Indian J Cardiovasc Dis Women-WINCARS 2018;3:204–208. DOI: https://doi.org/10.1055/s-0038-1676912
  13. Kawamoto Y, Nishihara T, Aono J, Nandate H, Hamada T, Yasuoka T, et al. Perioperative management of emergent cesarean section in a patient with peripartum cardiomyopathy and orthopnea: a case report. J Int Med Res; 49. Epub ahead of print 2021. DOI: 10.1177/03000605211063077
  14. Martins LC, Freire CM, Capuruçu CA, Nunes MdoC, Rezende CA. Risk prediction of cardiovascular complications in pregnant women with heart disease. Arq Bras Cardiol 2016;106(4):289–296. DOI: https://doi.org/10.5935/abc.20160028
  15. Hemlata PG, 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 2017;11(9):UD01–UD03. DOI: https://doi.org/10.7860/jcdr/2017/28379.10579

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