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Heart Disease in Pregnancy - part 4

Trào ngược van hai lá nặng có thể được dung nạp kém trong thời kỳ mang thai chỉ trong ba trường hợp hiếm hoi khi trào ngược van hai lá cấp do vỡ của chordae lớn gây ra một sự gia tăng nhanh chóng trong áp lực điền; 16 nếu rung tâm nhĩ xảy ra với tỷ lệ thất rất nhanh chóng | Mitral valve prolapse 101 Severe mitral regurgitation can be poorly tolerated during pregnancy only in three rare instances when acute mitral regurgitation resulting from rupture of major chordae causes a rapid increase in filling pressure 16 if atrial fibrillation occurs with a very rapid ventricular rate and when long-standing severe mitral regurgitation is complicated by severe left ventricular dysfunction the prognosis being comparable to the prognosis of cardiomyopathy.15 Principles of treatment In the general population There is no need for treatment in asymptomatic patients who have mitral valve prolapse and no severe regurgitation. Beta blockers may be used in the case of severe or highly symptomatic arrhythmias.15 When mitral regurgitation is severe surgical correction is indicated in symptomatic patients.17 In asymptomatic patients surgery is indicated in patients when left ventricular ejection fraction is 60 or end-systolic diameter 45 mm.17 18 There is a current trend to consider surgery at an earlier stage in asymptomatic patients with severe mitral regurgitation in particular when valve repair is feasible.18 19 Mitral valve repair is the preferred treatment for valve prolapse because operative mortality is lower and late results are better than after prosthetic valve replacement.20 21 However the feasibility of mitral valve repair depends on valve anatomy. When valve prolapse involves the mid-scallop of the posterior leaflet P2 valve repair is feasible in most cases and offers good long-term results.22 Results may be less satisfactory in the case of extensive bivalvular prolapse in particular when involving commissural areas. Calcification of the mitral annulus can also compromise the feasibility of valve repair. Thus it is mandatory to take into account the likelihood of valve repair according to echocardiographic analysis and the experience of the surgeon when considering early surgery in patients with severe mitral regurgitation.23 In young women .