Background:
Mitral stenosis is one of the most commonly encountered valvular heart diseases
during pregnancy, the majority are rheumatic in origin and poorly tolerated due to
cardiocirculatory changes that occur during pregnancy, labor and postpartum.
Objective:
The distinctive physiological events that arise during pregnancy and labor and the influence
of mitral stenosis are tackled in this article.
Methods:
Through PUBMED and MEDLINE searches, we reviewed the literature of the last decade
as well as the recommendations from guidelines of high-impact worldwide.
Results:
Cardiac decompensation usually takes place late in pregnancy as the hemodynamic burden
of pregnancy become more pronounced as well as after delivery due to an abrupt increase of preload
secondary to autotransfusion and aorto-caval decompression. The maternal and fetal complications
correlate with the New York Heart Association (NYHA) functional classification and the grade of
mitral stenosis. Medical therapy should be tried first. If symptoms continue in spite of optimal medical
therapy, invasive procedures are recommended. Several studies revealed that vaginal delivery under
epidural anesthesia is endurable and of low-risk unless obstetrically contraindicated.
Conclusion:
Pregnancy and mitral stenosis remain a complex entity and a well-known trigger of maternal
mortality during pregnancy and peri-partum period if not managed adequately. A good appreciation
and recognition of the physiology of pregnancy and its impact on the pre-existing mitral stenosis
and the presence of a specialized multidisciplinary team to handle such cases significantly decrease
maternal and fetal mortality and morbidity.
Noonan Syndrome: Cardiac Decompensation due to Severe Hypertrophic Obstructive Cardiomyopathy in Pregnancy