78th Annual PostGraduate Assembly in Anesthesiology (PGA78) 2024

Management and Anesthetic Considerations for Mitral Stenosis in Pregnancy

Introduction

-Mitral stenosis (MS) is the most common valvular lesion managed during pregnany and the prevalence is higher in areas of the world with more rheumatic heart disease

-Increased cardiac output (secondary to 30-40% increase in preload, 10-20% increase in HR) is poorly tolerated due to restricted ventricular inflow and resultant increase in left atrial and pulmonary pressures

-In up to a quarter of women, pregnancy may be the first time a diagnosis of MS is made (4)

-Adverse maternal events in women with mitral stenosis include pulmonary edema, arrhythmia, and thromboembolism

-Women with moderate or severe MS (mitral valve area (MVA) 1.5cm2), baseline maternal NYHA class III or IV, or a history of cardiac complications before pregnancy represent the groups at highest risk of maternal complications

-In symptomatic women with severe valvular heart disease who are considering pregnancy, intervention before pregnancy is recommended on basis of standard indications – Class I recommendations from the 2020 ACC/AHA guidelines

-Percutaneous balloon mitral valvuloplasty (PBMV) is effective and safe during pregnancy and is the preferred procedure for improving mitral valve area and gradients

78th Annual PostGraduate Assembly in Anesthesiology (PGA78) 2024

Management and Anesthetic Considerations for Mitral Stenosis in Pregnancy

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