{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:38:58Z","timestamp":1791261538646,"version":"4.1.0"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,2,28]],"date-time":"2021-02-28T00:00:00Z","timestamp":1614470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Rheumatic heart disease (RHD) is a disease of disparity most prevalent in developing countries and among immigrant populations. Mitral stenosis (MS) is a common sequalae of RHD and affects females disproportionately more than males. Rheumatic MS remains a significant management challenge as severe MS is usually poorly tolerated in pregnancy due to haemodynamic changes and increased cardiovascular demands of progressing pregnancy. Pregnancy remains contraindicated in current management guidelines based on expert consensus, due to a paucity of evidence-based literature.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 28-year-old aboriginal woman with known severe MS was found to be pregnant during routine health review, despite contraceptive efforts. Echocardiography demonstrated mean mitral valve (MV) gradient 14\u2009mmHg; stress echocardiography demonstrated increased MV gradient 28\u201332 mmHg at peak exercise and post-exercise pulmonary artery pressure 56\u2009+\u20093\u2009mmHg with marked dynamic D-shaped septal flattening. Left ventricular systolic function remained preserved. She remained remarkably asymptomatic and underwent successful elective induction of labour at 34\u2009weeks. Postpartum, she remained euvolaemic despite worsening MV gradients and new atrial fibrillation (AF). She subsequently underwent balloon mitral valvuloplasty with good result.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Severe rheumatic MS in pregnancy carries significant morbidity and mortality, due to an already fragile predisposition towards heart failure development compounded by altered haemodynamics. Pregnancy avoidance and valvular intervention prior to conception or in the second trimester remain the mainstay of MS management; however, we present an encouraging case of successful near-term pregnancy with minimal complications in a medically managed asymptomatic patient with critical MS, who subsequently underwent valvular intervention post-partum.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab010","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T09:26:55Z","timestamp":1614850015000},"source":"Crossref","is-referenced-by-count":6,"title":["Managing asymptomatic severe rheumatic mitral stenosis in pregnancy: a case report"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7526-2078","authenticated-orcid":false,"given":"Joanne","family":"Eng-Frost","sequence":"first","affiliation":[{"name":"Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Sinhal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Level 6, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8576-4661","authenticated-orcid":false,"given":"Marcus","family":"Ilton","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT 0810, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwina","family":"Wing-Lun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT 0810, Australia"},{"name":"Faculty of Health and Medicine, University of Sydney, Science Road, Camperdown, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,28]]},"reference":[{"key":"2021030409195774200_ytab010-B1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1258\/om.2008.080002","article-title":"Mitral valve disease in pregnancy: outcomes and management","volume":"2","author":"Tsiaras","year":"2009","journal-title":"Obstet Med"},{"key":"2021030409195774200_ytab010-B2","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/S0002-9149(03)00339-4","article-title":"Cardiac risk in pregnant women with rheumatic mitral stenosis","volume":"91","author":"Silversides","year":"2003","journal-title":"Am J Cardiol"},{"key":"2021030409195774200_ytab010-B3","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1161\/CIRCULATIONAHA.117.032561","article-title":"Pregnancy outcomes in women with rheumatic mitral valve disease. Results from the Registry of Pregnancy and Cardiac Disease","volume":"137","author":"Van Hagen","year":"2018","journal-title":"Circulation"},{"key":"2021030409195774200_ytab010-B4","first-page":"1","article-title":"Mitral stenosis in pregnant patients","volume":"16","author":"Youssef","year":"2018","journal-title":"E-J Cardiol Pract"},{"key":"2021030409195774200_ytab010-B5","doi-asserted-by":"crossref","first-page":"3147","DOI":"10.1093\/eurheartj\/ehr218","article-title":"ESC Guidelines on the management of cardiovascular disease during pregnancy","volume":"32","author":"Regitz-Zagrosek","year":"2011","journal-title":"Eur Heart J"},{"key":"2021030409195774200_ytab010-B6","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/S0195-668X(03)00201-X","article-title":"A prospective survey of patients with valvular heart diseases in Europe: the Euro Heart Survey on Valvular Heart Disease","volume":"24","author":"Iung","year":"2003","journal-title":"Eur Heart J"},{"key":"2021030409195774200_ytab010-B7","author":"Australian Institute of Health and Welfare"},{"key":"2021030409195774200_ytab010-B8","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/CRD.0000000000000185","article-title":"Medical management of rheumatic heart disease: a systematic review of evidence","volume":"26","author":"Russell","year":"2018","journal-title":"Cardiol Rev"},{"key":"2021030409195774200_ytab010-B9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jacc.2005.02.085","article-title":"Valvular heart disease and pregnancy: Part I: Native valves","volume":"46","author":"Elkayam","year":"2005","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/3\/ytab010\/36415155\/ytab010.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/3\/ytab010\/36415155\/ytab010.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T09:27:06Z","timestamp":1614850026000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytab010\/6154457"}},"subtitle":[],"editor":[{"given":"Elena","family":"Cavaretta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Danny","family":"can de Sande","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Marcelo","family":"Haertel Miglioranza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Matteo","family":"Parollo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Mariame","family":"Chakir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,2,28]]},"references-count":9,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,2,28]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytab010","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2021,2,28]]},"article-number":"ytab010"}}