Managing Pregnancy in the Presence of Rheumatic Heart Disease and Antiphospholipid Syndrome.

BACKGROUND

Rheumatic heart disease remains a major cause of maternal morbidity and mortality in low- and middle-income countries. The coexistence of severe mitral stenosis (MS) and antiphospholipid syndrome presents an exceptionally high-risk clinical scenario requiring multidisciplinary management.

CASE SUMMARY: A 31-year-old woman with severe rheumatic MS and antiphospholipid syndrome presented at 20 weeks of gestation with shortness of breath and palpitations. Echocardiography confirmed severe MS, with a valve area of 0.8 to 0.9 cm2. Despite optimal medical therapy, she remained symptomatic and underwent successful percutaneous transvenous mitral commissurotomy under local anesthesia. Postprocedure, the mitral valve area increased to 1.5 cm2, and she delivered a healthy baby at term without complications.

DISCUSSION: Pregnancy in women with rheumatic MS and antiphospholipid syndrome demands coordinated care to balance hemodynamic and thrombotic risks while ensuring fetal safety.

TAKE-HOME MESSAGE: Timely cardiac intervention, multidisciplinary collaboration, and individualized care enable favorable maternal and fetal outcomes in complex high-risk pregnancies.