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 .