Transventricular mitral commissurotomy in critical mitral stenosis during pregnancy

The management of a pregnant patient with mitral stenosis is a subject of debate with regards to the optimal type of treatment and the time of intervention. We performed trans-ventricular mitral commissurotomy (TVMC) either as an isolated procedure in the second trimester, or in combination with Cesarian section at term. We retrospectively analyzed our experience with TVMC during pregnancy and formulated a protocol for its management. Between January 1987 and April 2002, fifty one patients underwent TVMC for critical mitral stenosis during pregnancy. In 38 patients, elective TVMC was performed during the second trimester, while in 12, it was performed as an initial procedure along with Cesarian section at term. One patient had an emergency TVMC in the second trimester when she presented with intractable acute pulmonary edema. There were no maternal mortalities. Three patients who developed post-operative mitral regurgitation were managed conservatively. Another two patients who developed cerebral embolism with hemiplegia recovered completely without any neurological deficit. There was only one fetal death in a patient where TVMC was performed as an emergency procedure for acute pulmonary edema. We conclude that TVMC in pregnancy is a safe, cost effective alternative in critical mitral stenosis complicating pregnancy.