"percutaneous balloon mitral valvotomy with the guide of transesophageal echocardiography during pregnancy"

rheumatic mitral valve stenosis is the most common form of organic heart disease encountered during pregnancy and continues to cause maternal and fetal mortality. medically refractory congestive heart failure due to mitral stenosis is a clinical challenge and its optimal management remains controversial. on the other hand due to hazard of x-ray to mother and fetus, there are some limitations for perceutaneous balloon mitral valvotomy (pbmv) with fluoroscopy. therefore, we performed pbmv with the guide of transesophageal echocardiography (tee) with inoue method in 18 pregnant women with nyha class 3 or 4 due to mitral stenosis during pregnancy. the average procedure time was 29.9 (20-40) min and the average fluoroscopy time was 51.7 (28-101) seconds. the average nyha class decreased from 3.11 to 1.33. there was no maternal or fetal complication or mortality and no premature delivery occurred. overall risk to fetus was lower than previous reports of surgical commisurotomy performed during pregnancy. pbmv can be performed safely during pregnancy with the guide of tee and is effective in reliving symptoms of severe congestive heart failure. it offers an effective alternative for the pregnant patients with severe mitral stenosis when congestive heart failure is not controlled by conventional medical treatment.