Pediatrics & Therapeutics
Open Access

Mitral stenosis in pregnancy- Management options

International Conference on Pediatrics & Gynecology

6-8 December 2011 Philadelphia Airport Marriott, USA

Seema Chopra

Post Graduate Institute of Medical Education and Research, India

Posters & Accepted Abstracts: Pediatr Therapeut

Abstract :

Mitral valve stenosis is a state of relatively of fi xed cardiac output.Normal mitral valve area is 4 to 5cmsq. Symptoms with exercise seen with valve area of less than 2.5cmsq.Symptoms at rest are expected at area of 1.5 or less.Severe stenosis is area less than 1cmsq.

Prepregnancy: Goal is to defi ne the severity of disease.2D echo and color doppler are method used .Allows noninvasive evaluation and decrease need for cardiac catheterization.

Prenatal: Aim is to avoid cardiac decompsation.Symptoms of other fi ndings should be reported promptly.Avoid maternal tachycardia, restrict physical activity

Medical management: B –Blockers used empirically to prevent the tacycardia .AF can be managed with digoxin or cardioversion .Serial echoes are used to follow cardiac function objectively

Surgical management: Surgical commissurotomy is the traditional modality. Percutaneous mitral valve commissurotomy is prefered alternative.Closed mitral valvotomy is another option

BMV-Advantages: Safe,As eff ective as surgical approach,Less invasive,Less expansive,Prefered as fi rst line in prenatel period. Indications severe sysmptomatic mitral stenosis .Refractory pulmonary oedema despite medical management

Factors to be evaluated Echocardiographicaly:

Valvular rigidity, valvular calcifi cation, valvular thickening, amount of subvalvular disease, four factors are evaluated from 0 to 4 depending on severity.
Contraindications

Absolute: Evidence of left atrial thrombus,Severe dilation of arotic root,Th orolumber scolosis Rotational abnormalities of heart,Th ickning of atrial septum>4mm.Recent thromboembolic event,Left ventricular thrombus , Relative Severe mitral valve calcifi cation,Severe subvalvular fi brosis Best time to perform Before pregnency ,During 2nd trimester,Aft er attaing the period of viability Complications Mitral regurgitation.Complications associated with trans septal puncture.
Uncomplicated procedure.Yielding MVA of 1.5cmsq or more.Or 40% increase in MVA.Immediate post op MR grade less than 3+