PERCUTANEOUS BALLOON MITRAL VALVOTOMY IN PREGNANCY

History and clinical findings: A 31-year-old woman with known postrheu matic mitral valve stenosis developed for the first time left heart fa ilure in the 19th week of her fifth pregnancy. After intensive drug tr eatment she was in stage 3 (New York Heart Association classification) . Apart from that the patient was in a good general condition and obst etrical status was according to the estimated duration of pregnancy. A uscultation revealed an apical diastolic murmur and mitral opening sna p. Investigations: Echocardiography demonstrated a mitral valve openin g area of 0.85 cm(2) (pressure-half time method); the mean gradient wa s 19 mm Hg. Treatment and course: Because of the severity of the findi ngs a percutaneous transvenous balloon valvotomy (according to Inoue) was performed in the 27th week of pregnancy, after careful lead shield ing of abdomen and pelvis, Radiological screening time was 10 min. The invasively measured transvalvar pressure gradient was reduced from 28 to 4 mm Hg, echocardiographically determined mitral opening area incr eased to 1.5 cm(2). Delivery was induced in the 36th week of pregnancy because of third-degree renal pelvis congestion. A healthy child, wei ghing 2850 g was delivered vaginally. Conclusion: High-grade symptomat ic mitral stenosis can, if necessary, be treated with a low-risk to mo ther and child by percutaneous balloon valvotomy.