Dilatation mitrale percutanée des rétrécissements mitraux en hypertention pulmonaire importante au cours de la grossesse

Rheumatic mitral stenosis is the most common organic valvular heart disease in developing countries. These patients are at risk of decompensation during pregnancy. We here describe our experience with percutaneous dilation of mitral stenosis in patients with severe pulmonary hypertension during pregnancy. Percutaneous balloon mitral valve commissurotomy was performed in two hundred and twenty-three pregnant women between January 2009 and December 2015. Forty-three (19%) of these patients had severe pulmonary hypertension (SPAP > 70 mmHg). All pregnant women in our study had very severe symptomatic rheumatic mitral stenosis despite well-performed medical treatment. All patients had clinical improvement after percutaneous balloon mitral valve commissurotomy. The severity of mitral insufficiency progressed by one grade in two patients. One patient had tamponade with favorable outcome after a pericardial puncture. No abortion occurred after the procedure and two preterm deliveries were reported. Patients with severe rheumatic mitral stenosis during pregnancy should receive multidisciplinary care involving an obstetrician, anesthetist and cardiologist. Percutaneous balloon mitral valve commissurotomy is currently the standard treatment for rheumatic mitral stenosis during pregnancy.