Successful outcome of pregnancy in RHD with severe MS, severe pulmonary artery hypertension, moderate MR/TR/AR and mild AR

Anjali Rani, Prashanta Krishna Gupta


Rheumatic heart disease with severe Pulmonary Arterial Hypertension (PAH) in pregnancy is a grave situation, present with high maternal morbidity and mortality. In this case report, we describe our successful management of such a case which was even more difficult in combination with sever mitral stenosis, severe pulmonary artery hypertension and mild to moderate MR/TR. This patient got her diagnosis late in pregnancy, beyond the time at which a therapeutic termination could not have been performed.


RHD, Pregnancy, PAH, MS

Full Text:



Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous ballon dilatation of the mitral valve: an analysis of echocardiographic variables related tooutcome and the mechanism of dilatation. Br Heart J. 1988;60:299-308.

Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. United Kingdom obstetric surveillance system (UKOSS). In: Knight M, Kurinczuk JJ, Spark P, Brocklehurst P, eds. Annual Report 2007. Oxford: National Perinatal Epidemiology Unit; 2007: 1-22.

Weiss BM, Zemp L, Seifert B et al. Outcome of Pulmonary vascular diease in pregnancy: a systemic overview from 1978 through 1996. J Am Coll Cardiol. 1998;31:1650-7.

Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JA, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G, ESC Committee for practice Guidelines (CPG). Guideline for diagnosis and treatment of pulmonary hypertension: the task force for diagnosis and treatment of pulmonary hypertension of the European society (ESR), endorsed by international society of heart and lung transplantation (ISHLT). Eur Heart J. 2009;30(20):2493-537.

Duarte AG, Thomas S, Safdar Z, Torres F, Pacheco LD, Feldman J, deBoisblance B. Management of pulmonary arterial hypertension during pregnancy-a retrospective, multi-centre experience. Chest. 2013;143(5):1330-6.

Kiely DG, Condliffe R, Webstar V, Mills GH, Wrench I, Gandhi SV, Selby K, Armstrong IJ, Martin L, Howarth ES, Bu’Lock FA, Stewart P, Elliott CA. Improved survival in pregnancy and pulmonary hypertension using a multi-professional approach. Beilstein J Org Chem. 2010;117:565-74.

Gomar C, Frrando CL. Neuroaxial anesthesia in obstetrical patient with cardiac disease. Curr Opin Anesthesiol. 2005;18:507-12.

Bomnnin M, Mercier FJ, Sitbon O, Roger-Christoph S, Jais X, Humbert M, Audibert F, Frydman R, Simonneau G, Benhamou D. Severe pulmonary hypertension during pregnancy mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiol. 2005;102:1133-7.