The Patient with severe stenosis of the mitral valve first diagnosed in the third trimester of pregnancy

Abstract

Mitral valve stenosis is a form of heart valve disease characterized by narrowing of the mitral valve orifice. Mitral stenosis represents 12% of valvular heart diseases, and the main cause is rheumatic disease - in 85% and degenerative, caused by calcification of the ventricles - in 12%.

A 26-year-old woman was transferred from the regional clinic at the 27th week of pregnancy, in a serious condition, with a combined malformation of the mitral valve, a severe degree of stenosis and deficiency, which caused narrowing of the pulmonary circulation and acute respiratory failure. Bilateral hydrothorax was expressed, which was drained during admission. The patient periodically required non-invasive artificial ventilation (CPAP). On the background of forced diuresis, stable cardiac compensation was achieved, although the risks of repeated decompensation were high as pregnancy progressed. Accordingly, an interdisciplinary council was held with the participation of cardiologists, mid-gynecologists, cardioanesthesiologists, cardiac surgeons and neonatologists. The issue of theoretical judgment was: 1. Termination of pregnancy, 2. Possibility of intervention (balloon valvuloplasty), 3. Possibilities of surgical treatment.

    The Consilium agreed to continue the pregnancy under strict monitoring, with a caesarean section performed at the earliest signs of decompensation. As a result of the joint, coordinated work of different disciplines, the pregnancy was brought to 35 weeks, after which a planned cesarean section was performed.

    6 weeks after caesarean section, the patient underwent mitral valve replacement with a mechanical valve. Both times the postoperative period was without complications, mother and child feel well.