Management of mitral valve stenosis in pregnancy: case presentation and review of the literature.

Severe mitral stenosis is a challenging complication in pregnancy. A case is described in which mitral valve replacement was undertaken immediately following caesarean section at 34 weeks' gestation. A review of the literature discusses the evolution of treatment approaches for mitral stenosis in pregnancy, including open mitral commissurotomy and percutaneous mitral commissurotomy with the use of balloon catheters. With balloon procedures, potential risks to the fetus are minimized because the abdomen and pelvis are shielded. In addition, the use of adjunct transesophageal echocardiography shortens fluoroscopic time. In the case described, neither open nor percutaneous mitral commissurotomy were viable options because of moderate-to-severe mitral regurgitation and a heavily calcified valve. This is one of few such cases reported in the literature to date.