Waktu Ideal untuk Terminasi Kehamilan pada Pasien dengan Hipertensi Paru Berat akibat Stenosis Mitral Berat: Sebuah Laporan Kasus

Abstract

Pulmonary hypertension due to mitral stenosis is a common condition and is associated with Major Adverse Cardiac Events (MACE) in pregnancy. A 27-year-old woman, 7-month-old pregnant with her second child, came with complaints of shortness of breath that she has experienced for the last 3 months, accompanied by others signs and symptoms of heart failure. Vital signs within normal limits. On physical examination, JVP is elevated by 4 cm and there is a pansystolic murmur at apex and mid-diastolic murmur at the fourth intercostal space of the left sternal border, legs are edematous with warm extremities. Electrocardiography shows atrial fibrillation with right axis deviation, right ventricle hypertrophy, and complete right bundle branch block. Echocardiography shows MVA 0.45 cm², TR VMax 4.7 cm/s, TVG 89 mmHg, TAPSE 1.2cm, PASP 109 mmHg. On chest x-ray, there is cardiomegaly with double contour sign, flattened waist sign of the heart, protrusion of the pulmonary segments, and pruning of pulmonary vessels. The pregnancy is terminated by caesarean section with spinal anesthesia due to cardiovascular events. MACE in mother include heart failure, arrhythmias, and thromboembolism. Meanwhile the complications in the fetus/infant include death, growth retardation, low birth weight and premature birth. Period and method of pregnancy termination in pulmonary hypertension is based on maternal condition and fetal viability.