When 26-year-old Anita (name changed) was 8.5 months into her pregnancy, she developed breathlessness. Initially, her family members attributed it to pregnancy nearing term. But when it became severe and she was unable to lie down, family members rushed her to the emergency at Narayana Multispeciality Hospital, Jaipur where it was discovered that she had associated severe mitral valve stenosis (narrowing of the heart valve). She was initially medically stabilized & underwent successful treatment. Subsequently, she delivered healthy twins.
Like Anita, thousands of pregnant women in India suffer from Cardiac valve related disorders which complicate approximately 1-3% of the pregnancies. Various physiological changes which occur during pregnancy make patients with borderline heart defects symptomatic and realize abnormalities which had hitherto remained unknown.
“Anita had severe mitral valve stenosis (narrowing of the heart valve between LA & LV), which had caused congestion in the lungs leading to the breathlessness. She was already 33 weeks into her pregnancy with twins, which made the case extremely challenging as such corrective procedures is ideally performed between 24th – 26th week. If a Caesarean operation was performed without correcting the cardiac defect, it would mean putting the lives of both the mother and unborn twins at risk, as mortality rate in such cases is as high as 20-30 percent” said Dr. Sanjay Sharma, Consultant – Interventional Cardiology who treated the patient.
When the patient was brought to the hospital, she was medically stabilized as the patient was unable to even lie down due to severe breathlessness. A multidisciplinary team comprising of Cardiologist Dr. Sanjay Sharma, Gynecologist Dr. Manju Goyal, Sr. Cardiac Surgeon Dr. Ankit Mathur, Sr. Anesthetist Dr. Pradeep Goyal and Neonatologist Dr. Vijay Shankar Sharma was formed to plan the entire course of treatment, delivery & post-operative care.
On day 3, one of the foetus started showing signs of distress. The patient was taken to the hospital Cath Lab & an emergency BMV procedure was performed. Through a small nick in the groin, a catheter with an inflatable balloon was inserted which helped expand the narrowed mitral valve, thereby correcting her valvular condition. Immediately thereafter an emergency Caesarean Operation in the hospital’s OT helped deliver two healthy yet premature babies. The twins were kept under Intensive Care in the hospital’s Neonatal ICU until they were healthy enough to be discharged.
A corrective procedure can be safely performed around six months (24-26 weeks) of pregnancy with good success rate. Any intervention beyond the 26th week carries high risk. This case was challenging as it was a late presentation with twin pregnancy (in the 33rd week) and the patient had fluid build-up around the heart’s protective membrane (pericardial effusion) which made entry into the heart difficult added Dr. Sanjay Sharma Consultant – Interventional Cardiology who treated the patient.