Prognostic factors of rheumatic mitral stenosis during pregnancy and puerperium

Arq Bras Cardiol. 2000 Sep;75(3):215-24. doi: 10.1590/s0066-782x2000000900003.
[Article in English, Portuguese]


Objective: To identify characteristics associated with complications during pregnancy and puerperium in patients with rheumatic mitral stenosis.

Methods: Forty-one pregnant women (forty-five pregnancies) with mitral stenosis, followed-up from 1991 to 1999 were retrospectively evaluated.

Predictor variables: the mitral valve area (MVA), measured by echocardiogram, and functional class (FC) before pregnancy (NYHA criteria). Maternal events: progression of heart failure, need for cardiac surgery or balloon mitral valvulotomy, death, and thromboembolism. Fetal/neonatal events: abortion, fetal or neonatal death, prematurity or low birth weight (<2,500 g), and extended stay in the nursery or hospitalization in newborn ICU.

Results: The mean +/- SD of age of the patients was 28.8+/-4.6 years. The eventful and uneventful patients were similar in age and percentage of first pregnancies. As compared with the level 1 MVA, the relative risk (RR) of maternal events was 5.5 (95% confidence interval (CI) =0.8-39.7) for level 2 MVA and 11.4 (95% CI=1.7-74.5) for level 3 MVA. The prepregnancy FC (FC > or = II and III versus I) was also associated with risk for maternal events (RR=2.7; 95% CI=1.4-5.3).MVA and FC were not importantly associated with these events, although a smaller frequency of fetal/neonatal events was observed in patients who had undergone balloon valvulotomy.

Conclusion: In pregnant women with mitral stenosis, the MVA and the FC are strongly associated with maternal complications but are not associated with fetal/neonatal events. Balloon mitral valvulotomy could have contributed to reducing the risks of fetal/neonatal events in the more symptomatic patients who had to undergo this procedure during pregnancy.

MeSH terms

  • Adult
  • Confidence Intervals
  • Echocardiography
  • Female
  • Fetal Diseases / physiopathology
  • Humans
  • Mitral Valve Stenosis / complications
  • Mitral Valve Stenosis / physiopathology*
  • Parity
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / physiopathology*
  • Prognosis
  • Rheumatic Heart Disease / complications
  • Rheumatic Heart Disease / physiopathology*
  • Risk