Management of pregnancy with severe rheumatic mitral stenosis presenting at term in congestive heart failure: our experience.

BACKGROUND: Rheumatic heart disease (RHD) remains a major cause of maternal morbidity in low- and middle-income countries, particularly among women of childbearing age. Severe mitral stenosis in pregnancy can lead to acute decompensated heart failure, especially in the third trimester. Timely intervention is essential but challenging in late presenters. We describe a series of three pregnant women presenting at term with severe rheumatic mitral stenosis complicated by heart failure. All underwent emergency lower segment cesarean section (LSCS) followed by balloon mitral valvotomy (BMV) in the same operative setting. Transesophageal echocardiography (TEE) was used for transseptal puncture to reduce radiation exposure, and abdominal lead shielding was applied. The radiation dose was limited to 249 mGy. Two patients had favorable maternal and fetal outcomes, while one patient succumbed due to septic shock despite successful valvotomy.

CONCLUSION: Simultaneous LSCS and BMV is a feasible and potentially life-saving strategy in women presenting late in pregnancy with severe mitral stenosis and heart failure. A multidisciplinary approach with individualized hemodynamic and fetal considerations is critical. We propose that this time-sensitive strategy may improve outcomes in resource-limited settings.