Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series
Background: Valvular heart disease in pregnancy is still not widely studied. The combination of mitral stenosis and the physiology of pregnancy for both mother and fetus often result in poor hemodynamics, and management during labor and peripartum period greatly determines the prognosis of both live...
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Fakultas Kedokteran, Universitas Diponegoro
2023-11-01
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| Series: | JAI (Jurnal Anestesiologi Indonesia) |
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| Online Access: | https://ejournal.undip.ac.id/index.php/janesti/article/view/57727 |
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| author | Lourensia Brigita Astern Praha Rizqon Rohmatussadeli M. Fauziar Ahnaf Besari Adi Pramono Rahmad Rizal Wicaksono R. Soerjo Hadijono |
| author_facet | Lourensia Brigita Astern Praha Rizqon Rohmatussadeli M. Fauziar Ahnaf Besari Adi Pramono Rahmad Rizal Wicaksono R. Soerjo Hadijono |
| author_sort | Lourensia Brigita Astern Praha |
| collection | DOAJ |
| description | Background: Valvular heart disease in pregnancy is still not widely studied. The combination of mitral stenosis and the physiology of pregnancy for both mother and fetus often result in poor hemodynamics, and management during labor and peripartum period greatly determines the prognosis of both lives.
Case: A 42 years old G3P2A0 (Case A) and A 33 years old G3P1A1 (Case B) both had a history of previous SC labor, presented worsening shortness of breath since 2nd trimester, coughing and swelling in both legs, also unable to rest in a flat position. especially, case B was frequent re-hospitalized with prolonged LOS during 2nd – the 3rd trimester due to acute lung edema. We found a mid-diastolic murmur grade II/IV at the apex. Electrocardiography (ECG) of case A: sinus rhythm, left atrial enlargement (LAE), while case B: AF rapid response. The echocardiography of case A revealed severe MS, while case B revealed severe MS, moderate tricuspid regurgitation and, a high probability for PH. Those findings support the diagnosis of severe mitral stenosis and rheumatic heart disease in pregnancy, then they were programmed to do balloon mitral valvuloplasty (BMV) in 3rd trimester.
Discussion: The BMV was performed, and succeeded in case A reducing the mitral valve pressure gradient (MV PG) from 24.7mmHg to 12.1mmHg by using local anesthesia along the procedure, while in case B specifically done BMV with general anesthesia due to supraventricular tachycardia (SVT) and pulmonal congestive during procedure, reducing the MV PG from 17.7mmHg to 8.6mmHg, as well as improvement in symptoms, up to pregnancy was terminated as obstetric indication by SC on 36-37 weeks' gestation in both cases. The baby born was healthy with weights of each case 2340gr and 2630gr.
Conclusion: Mitral stenosis in the peripartum needs to be managed by interprofessional collaboration properly, to decrease the risk of morbidity and mortality for the mother and fetus. |
| format | Article |
| id | doaj-art-127edd04132b4f0e9da3c03bd289446c |
| institution | OA Journals |
| issn | 2337-5124 2089-970X |
| language | English |
| publishDate | 2023-11-01 |
| publisher | Fakultas Kedokteran, Universitas Diponegoro |
| record_format | Article |
| series | JAI (Jurnal Anestesiologi Indonesia) |
| spelling | doaj-art-127edd04132b4f0e9da3c03bd289446c2025-08-20T01:56:24ZengFakultas Kedokteran, Universitas DiponegoroJAI (Jurnal Anestesiologi Indonesia)2337-51242089-970X2023-11-0115323123810.14710/jai.v15i3.5772723100Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case SeriesLourensia Brigita Astern Praha0Rizqon Rohmatussadeli1M. Fauziar Ahnaf2Besari Adi Pramono3Rahmad Rizal Wicaksono4R. Soerjo Hadijono5Department of Cardiology and Vascular, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, IndonesiaDepartment of Cardiology and Vascular, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, IndonesiaDepartment of Cardiology and Vascular, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, IndonesiaDepartment of Obstetrics-gynecology, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, IndonesiaDepartment of Obstetrics-gynecology, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, IndonesiaDepartment of Obstetrics-gynecology, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, IndonesiaBackground: Valvular heart disease in pregnancy is still not widely studied. The combination of mitral stenosis and the physiology of pregnancy for both mother and fetus often result in poor hemodynamics, and management during labor and peripartum period greatly determines the prognosis of both lives. Case: A 42 years old G3P2A0 (Case A) and A 33 years old G3P1A1 (Case B) both had a history of previous SC labor, presented worsening shortness of breath since 2nd trimester, coughing and swelling in both legs, also unable to rest in a flat position. especially, case B was frequent re-hospitalized with prolonged LOS during 2nd – the 3rd trimester due to acute lung edema. We found a mid-diastolic murmur grade II/IV at the apex. Electrocardiography (ECG) of case A: sinus rhythm, left atrial enlargement (LAE), while case B: AF rapid response. The echocardiography of case A revealed severe MS, while case B revealed severe MS, moderate tricuspid regurgitation and, a high probability for PH. Those findings support the diagnosis of severe mitral stenosis and rheumatic heart disease in pregnancy, then they were programmed to do balloon mitral valvuloplasty (BMV) in 3rd trimester. Discussion: The BMV was performed, and succeeded in case A reducing the mitral valve pressure gradient (MV PG) from 24.7mmHg to 12.1mmHg by using local anesthesia along the procedure, while in case B specifically done BMV with general anesthesia due to supraventricular tachycardia (SVT) and pulmonal congestive during procedure, reducing the MV PG from 17.7mmHg to 8.6mmHg, as well as improvement in symptoms, up to pregnancy was terminated as obstetric indication by SC on 36-37 weeks' gestation in both cases. The baby born was healthy with weights of each case 2340gr and 2630gr. Conclusion: Mitral stenosis in the peripartum needs to be managed by interprofessional collaboration properly, to decrease the risk of morbidity and mortality for the mother and fetus.https://ejournal.undip.ac.id/index.php/janesti/article/view/57727anesthesia agentballoon mitral valvuloplastymitral stenosisperipartumpregnancy |
| spellingShingle | Lourensia Brigita Astern Praha Rizqon Rohmatussadeli M. Fauziar Ahnaf Besari Adi Pramono Rahmad Rizal Wicaksono R. Soerjo Hadijono Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series JAI (Jurnal Anestesiologi Indonesia) anesthesia agent balloon mitral valvuloplasty mitral stenosis peripartum pregnancy |
| title | Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series |
| title_full | Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series |
| title_fullStr | Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series |
| title_full_unstemmed | Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series |
| title_short | Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series |
| title_sort | double whammy cases of severe mitral stenosis in peripartum a survival case series |
| topic | anesthesia agent balloon mitral valvuloplasty mitral stenosis peripartum pregnancy |
| url | https://ejournal.undip.ac.id/index.php/janesti/article/view/57727 |
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