Percutaneous mitral commissurotomy in pregnant women: Immediate and long-term outcomes

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Published Mar 10, 2026
https://doi.org/10.62438/tunismed.v104i01.6450
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Vol. 104 No. 01 (2026): Tunis Med Jan 2026

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Selim Boudiche
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Abdeljalil Farhati
Cardiology Department, La Rabta Hospital, Tunis, Tunisia
Sofien Haboubi
Cardiology Department, Mongi Slim Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Manel Abbassi
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Mohamed Chedly
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Faten El Ayech Boudiche
Cardiology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Zeynab Jebbari
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Amal Ben Salem
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Khaled Ezzaouia
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Boutheina Besbes
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Foued Daly
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Rim Ben Rejeb
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Dhekra Sebki
Anesthesiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Ines Bounaoues
Department of Anesthesiology, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Mehrez Gouader
University of Tunis El Manar, Faculty of Medicine of Tunis, Anesthesiology Department, La Rabta Hospital, 1007, Tunis, Tunisia
Fathia Mghaieth
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Sana Ouali
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Noureddine Larbi
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Manel Ben Halima
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Mohamed Sami Mourali
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

Abstract

Background: Rheumatic mitral stenosis (MS) is prevalent in developing countries. Poorly tolerated during pregnancy, MS is often requiring urgent intervention.


Objectives: This study aimed to evaluate immediate and long-term outcomes after percutaneous (PMC) in pregnant women.


Methods: Observational retrospective study of pregnant women who underwent PMC for severe MS between January 2008 and December 2018. Primary endpoint was procedural success (mitral valve area > 1.5 cm²) without complications.


Results: 39 patients. Mean age 34.2±5.1 years. Mean gestational age 28.2±4.9 weeks. PMC was successful in 37 patients (94.8%). There was no maternal mortality. Two procedures failed (1 transseptal puncture failure and 1 severe traumatic mitral regurgitation requiring emergent surgery). If successful, PMC allowed the pursue of pregnancy until full term and vaginal delivery in 36 (92.3%) and 20 (51.3%) patients, respectively. One in utero foetal demise and one neonatal death occurred. At 56.1-month, after exclusion of three patients with prompt surgical valve replacement, there were 7 cases of mitral restenosis (19.4%) with Wilkins score >8, suboptimal result (valve area between 1.5 and 1.8 cm²) and incomplete bicommissural splitting as predictive factors. All babies maintained normal growth and development.


Conclusion: This study confirmed effectiveness and safety of PMC during pregnancy when performed by an experienced team with a procedural success of 94.8% but at the cost of a restenosis rate of 19.4% at 56.1 months. These were predicted, in addition to Wilkins score, by a suboptimal but accepted immediate result of the procedure, still allowing a step forward.

Keywords:

Mitral stenosis, Pregnancy, Mitral valvuloplasty

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