Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy

OBJECTIVES: To study the immediate maternal and fetal outcomes and long term maternal outcomes in pregnant women undergoing balloon mitral valvotomy. METHODS: We retrospectively analyzed balloon mitral valvotomy during pregnancy performed between January 2008 and July 2018. RESULTS: BMV was carried out in 97 pregnant women with mean age of 26.1 ± 4.5 years, at mean gestational age of 23.1 ± 4.6 weeks. The procedure was successful in 95 patients (97.9%). There was one maternal death post procedure due to intra-uterine death and disseminated intravascular coagulation. Adverse immediate fetal outcome was seen in 2 cases with one intra-uterine fetal demise and one preterm labour. Mitral valve area increased from mean of 0.82 ± 0.12 cm to 1.66 ± 0.14 cm (p < 0.001). Mean trans-mitral diastolic gradient decreased from 19.7 ± 5.6 mm Hg to 7.5 ± 2 mm Hg. Right ventricular systolic pressure decreased significantly from mean of 56.7 ± 16.2 mm Hg to mean of 35.6 ± 11 mm Hg. Survival analysis showed cumulative event free survival of 89% at 5 years and 65% at 10 years, considering a composite endpoint of clinical restenosis, repeat BMV or MVR or cardiovascular death. CONCLUSIONS: Balloon mitral valvotomy is a safe and effective treatment for severe mitral stenosis during pregnancy. Long term maternal outcomes after BMV done during pregnancy are good and comparable to that of BMV done in non-pregnant patients.