BACKGROUND: Cardiac disease is 1 of the major causes of maternal
mortality. We studied pregnancy outcomes in women with rheumatic
mitral valve disease.
METHODS: The Registry of Pregnancy and Cardiac Disease is an
international prospective registry, and consecutive pregnant women with
cardiac disease were included. Pregnancy outcomes in all women with
rheumatic mitral valve disease and no prepregnancy valve replacement
is described in the present study (n=390). A maternal cardiac event was
defined as cardiac death, arrhythmia requiring treatment, heart failure,
thromboembolic event, aortic dissection, endocarditis, acute coronary
syndrome, and hospitalization for other cardiac reasons or cardiac
intervention. Associations between patient characteristics and cardiac
outcomes were checked in a 3-level model (patient–center–country).
RESULTS: Most patients came from emerging countries (75%). Mitral
stenosis (MS) with or without mitral regurgitation (MR) was present in
273 women, isolated MR in 117. The degree of MS was mild in 20.9%,
moderate in 39.2%, severe in 19.8%, and severity not classified in the
remainder. Maternal death during pregnancy occurred in 1 patient with
severe MS. Hospital admission occurred in 23.1% of the women with MS,
and the main reason was heart failure (mild MS 15.8%, moderate 23.4%,
severe 48.1%; P1 was an
independent predictor of maternal cardiac events. Follow-up at 6 months
postpartum was available for 53%, and 3 more patients died (1 with
severe MS, 1 with moderate MS, 1 with moderate to severe MR).