[Percutaneous mitral commissurotomy with Inoue's technic and pregnancy. The initial experience in Mexico]

From March 1986 to January 1993, we performed percutaneous balloon mitral commissurotomy (PBMC) in ninety-one patients with rheumatic mitral stenosis, two of them during pregnancy. The gestational age at the time of valvotomy was thirty and twenty-seven weeks respectively. Balloon Inoue technique in both cases resulted in improvement in mitral valve area (0.8 vs 1.6 and 0.7 vs 1.9 cm2) and in mean mitral gradient (19 vs 4 and 12 vs 0 mm Hg) immediately after dilation, without residual atrial septal defect or mitral insufficiency. There were no complications. The estimated radiation exposure to the fetus was of 6.4 minutes of fluoroscopy and 6 seconds of angiography. To limit of X-ray irradiation, we used color Doppler echocardiography during dilatation in both cases. The subsequent course of gestation was uncomplicated and normal babies were delivered in both cases. Fetus protection against ionising radiation was assured by lead mantles. In the follow-up the mitral valve area was 1.7 and 2.1 cm2, 15 and 4 months later respectively. PBMC can be performed safely during pregnancy and is effective in increasing the valvular area and relieving symptoms. It offers an excellent alternative for the pregnant patients, with severe mitral stenosis. The risk to the fetus appears lower than previous reports of surgical commissurotomy performed during pregnancy.