although rheumatic heart disease is increasingly rare in developed countries , it remains the most common cardiac disorder in much of the world .
percutaneous mitral valvuloplasty has been shown to be a new therapy for patients with mitral stenosis and has achieved excellent results in the majority of patients with severe mitral stenosis .
this report describes our first clinical application with this procedure in a pregnant woman with severe rheumatic mitral stenosis .
she had been free of cardiac symptoms until one month prior to admission ( 25 weeks gestation ) .
she began to be treated with digoxin and diuretic therapy . on two days before admission
the blood pressure was 100/60 mmhg and the pulse rate was 120/min ; respirations were 28/min .
cardiac examination revealed a prominent right ventricular heaving . the first heart sound was increased and the second sound was narrowly split with an accentuated pulmonic component .
there were no abnormal findings on gynecological examination except enlarged uterus due to 26 weeks gestation .
after intensive treatment with diuretics she could remain in the supine position . to protect the fetus from radiation , she was wrapped in a lead shield from the diaphragm to the symphysis pubis .
fetal monitoring , including fetal heart rate , was done during the procedure . using the percutaneous femoral approach , a 7 fr .
after prevalvuloplasty measurements ( table 1 ) , transseptal catheterization was accomplished from the right femoral vein using a modified brockenbrough needle and an 8 fr .
systemic anticoagulation was achieved with 5000 units of heparin given after successful transseptal catheterization . left heart pressures and transvalvular gradients
wedge ballon catheter was advanced through the mitral and aortic valves to the descending aorta , followed by insertion of a 0.035 inch , 260 cm long teflon - coated exchange guide wire through the flow directed catheter .
the sheath and balloon catheter were then removed , leaving only the guide wire in place .
, a second guide wire was introduced to the descending aorta through the double lumen catheter which was inserted through the first guide wire .
were advanced across the septum through the left atrium and positioned across the mitral annulus .
two balloon inflations with a mixture of saline solution and iodinated contrast medium were then performed until the indentation in the balloon due to the mitral stenosis disappeared . immediately after catheter valvotomy , all hemodynamic measurements , including determinations of transvalvular gradient and cardiac output , were repeated ( table 1 ) .
figure 1 shows the simultaneous left atrial and left ventricular pressure before and after balloon dilatation .
there was a decrease in mean diastolic gradient across the mitral valve to 8 mmhg and an increase in cardiac output to 6.6 liters / min .
right heart oximetry demonstrated no evidence of a left to right shunt across the atrial septum . to minimize radiation exposure to the fetus , left ventricular
however , definite evidence of mitral regurgitation was not detected by physical examination and by doppler examination of the mitral valve .
the procedure was completed in 2 hours ( fluoroscope time ; 35 min . ) and the patient tolerated it well with minimal discomfort .
there was no evidence of fetal distress and the amount of radiation was 0.13 rem during the procedure .
she delivered a 3.51 kg , healthy , full - term boy without any evidence of fetal abnormalities .
follow - up examination of this boy for 17 months has shown normal growth and development .
after intensive treatment with diuretics she could remain in the supine position . to protect the fetus from radiation , she was wrapped in a lead shield from the diaphragm to the symphysis pubis .
fetal monitoring , including fetal heart rate , was done during the procedure . using the percutaneous femoral approach , a 7 fr .
after prevalvuloplasty measurements ( table 1 ) , transseptal catheterization was accomplished from the right femoral vein using a modified brockenbrough needle and an 8 fr .
systemic anticoagulation was achieved with 5000 units of heparin given after successful transseptal catheterization . left heart pressures and transvalvular gradients
wedge ballon catheter was advanced through the mitral and aortic valves to the descending aorta , followed by insertion of a 0.035 inch , 260 cm long teflon - coated exchange guide wire through the flow directed catheter .
the sheath and balloon catheter were then removed , leaving only the guide wire in place .
, a second guide wire was introduced to the descending aorta through the double lumen catheter which was inserted through the first guide wire .
were advanced across the septum through the left atrium and positioned across the mitral annulus .
two balloon inflations with a mixture of saline solution and iodinated contrast medium were then performed until the indentation in the balloon due to the mitral stenosis disappeared . immediately after catheter valvotomy ,
all hemodynamic measurements , including determinations of transvalvular gradient and cardiac output , were repeated ( table 1 ) .
figure 1 shows the simultaneous left atrial and left ventricular pressure before and after balloon dilatation .
there was a decrease in mean diastolic gradient across the mitral valve to 8 mmhg and an increase in cardiac output to 6.6 liters / min .
right heart oximetry demonstrated no evidence of a left to right shunt across the atrial septum . to minimize radiation exposure to the fetus , left ventricular
however , definite evidence of mitral regurgitation was not detected by physical examination and by doppler examination of the mitral valve .
the procedure was completed in 2 hours ( fluoroscope time ; 35 min . ) and the patient tolerated it well with minimal discomfort .
there was no evidence of fetal distress and the amount of radiation was 0.13 rem during the procedure .
she delivered a 3.51 kg , healthy , full - term boy without any evidence of fetal abnormalities .
follow - up examination of this boy for 17 months has shown normal growth and development .
our findings demonstrate that percutaneous mitral valvuloplasty is an effective and safe procedure for treating pregnant patients with mitral stenosis .
the patient had immediate symptomatic relief and the hemodynamic data showed significant relief of pulmonary hypertension and a significant increase in mitral valve area .
these favorable results suggest that prercutaneous mitral valvuloplasty could be the treatment of choice for selected pregnant patients with mitral stenosis refractory to medical treatment .
 a 28-year - old woman with severe mitral stenosis underwent percutaneous mitral valvuloplasty at 26 weeks gestation . 
 balloon dilation using a double 18 - 18 mm balloon resulted in improvement in mean mitral pressure gradient ( 32 to 8 mmhg ) and in calculated mitral valve area ( 0.9 to 2.4 cm2 ) without complications and any evidence of fetal distress during procedures with an estimated radiation exposure to the fetus of 0.13 rem . 
 this procedure resulted in the disappearance of symptoms of congestive heart failure and allowed for normal full term spontaneous delivery of a 3.51 kg boy without any complication . 
INTRODUCTION
CASE REPORT
1. Mitral Valvuloplasty
DISCUSSION