Assessment of Coronary Reserve Preservation in Pregnant Women with Mitral Stenosis
Keywords:
Mitral stenosis, coronary reserve, pregnancy, risk stratification, cardiovascular assessmentAbstract
Pregnant women with mitral stenosis (MS) face significant risks, with maternal mortality rates reaching 5%, increasing to 17% in cases of atrial fibrillation. This study aimed to develop a multifactorial scale for assessing coronary reserve preservation in pregnant women with atrioventricular orifice stenosis. A cohort of 124 pregnant women aged 17–32 years, at gestational ages of 12–38 weeks, underwent comprehensive evaluations. Assessments included respiratory rate, heart rate, blood pressure, oxygen saturation, echocardiographic parameters (ejection fraction, cardiac index, stroke volume), and functional tests such as the breath-holding test, six-minute step test, and nitroglycerin challenge. Prognostic scores were calculated to classify coronary reserves into preserved, reduced, severely reduced, and depleted categories. The findings revealed that the severity of mitral stenosis, cardiac index, ejection fraction, and functional test outcomes were critical predictors of coronary reserve status. Patients with critical mitral stenosis and severe hemodynamic impairments demonstrated sharply reduced reserves, highlighting the need for early, individualized interventions. This methodology supports evidence-based clinical decision-making, optimizing obstetric and anesthetic strategies, and improving maternal and fetal outcomes. Incorporating this scale into practice provides a cost-effective tool for stratifying cardiovascular risk in high-risk pregnancies.
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