ABSTRACT
The authors report the results of percutaneous mitral dilatation (PMD) during pregnancy in 11 cases of tight and poorly tolerated mitral stenosis (MS). This dilatation was performed on average at 22 +/- 5 weeks of pregnancy, protecting the fetus against radiation and using the double balloon technique. Fluoroscopy time, with a mean of 10.5 +/- 2.2 minutes, was greatly reduced in the last five patients by the elimination of cineangiography. Mitral insufficiency was then sought and estimated by colour Doppler. This also avoided iodine overload and its possible effects on the fetal thyroid. Mitral surface area and hemodynamic parameters were very significantly improved by PMD: mean capillary pressure fell from 25.1 +/- 6.2 to 10.7 +/- 4.4 mmHg, mean transmitral gradient from 18.8 +/- 6.2 to 5.9 +/- 2.9 mmHg and mitral surface area increased from 0.9 +/- 0.2 to 2.1 +/- 0.4 cm2 (p < 0.0001). Pregnancy continued under good hemodynamic conditions until delivery which occurred after 8 and a half months, vaginally, in 10 cases. Cesarean section was performed at 8 months in only one patient because of fetal distress not related to the dilatation and with a satisfactory outcome. The 11 children, now with a mean age of 18 months, are all well and free of any functional or organic abnormality. Measurement of thyroid hormone levels in the first 6 also proved normal. In the light of these results, PMD during pregnancy can be considered as an excellent alternative to surgery when it is possible in terms of the anatomical status of the mitral valve.
