Percutaneous mitral balloon valvotomy in pregnancy using the Inoue balloon technique

We describe a 40-year-old female who was 27 weeks pregnant and had severe rheumatic mitral valve stenosis. The patient presented with severe biventricular heart failure and fast atrial fibrillation. Soon after admission the patient sustained a cardiac arrest and was successfully resuscitated. Despite maximal medical therapy the patient was still in pulmonary edema. Beta blockers were contraindicated as the patient had bronchial asthma. Balloon mitral valvotomy using an Inoue 26 mm balloon catheter was done. The procedure was done with pelvic and abdominal shielding. To minimize radiation exposure no angiography was done and the procedure was done with echo-Doppler guided stepwise mitral valve dilatation. The mitral valve area after balloon valvotomy increased from 0.9 to 2 cm2. The total fluoroscopy time was 14 minutes. At 6-week follow-up the patient was virtually asymptomatic. Vaginal delivery was uneventful. Balloon mitral valvotomy using the Inoue technique in pregnancy with echo guided stepwise dilatation is accomplished with minimal radiation exposure, provided abdominal shielding is implemented throughout the procedure.