[Percutaneous mitral valvuloplasty with Inoue balloon and pregnancy]

Percutaneous mitral valvuloplasty with Inoue balloon was performed in seven pregnant women with severe mitral stenosis in NYHA state III or IV that were unresponsive to conventional management Usual technique was performed with echocardiographic score of 8 or less except one and average gestational age of 28.5 +/- 6.4 weeks. The mean mitral gradient was 19.8 +/- 6.4 mmHg, and decreased to 3.6 +/- 2.9 mmHg (P < 0.01) and valvular area increased from 0.84 +/- 0.01 to 2.2 +/- 0.05 (P < 0.01) in 5 from 7 (P < 0.05) there was minimal mitral incompetence, there were no cases of atrial septal defect. Two patients had moderate to severe pulmonary hypertension which decreased immediately after treatment. All patients showed an improvement (P < 0.001) in the clinical state. Mean fetal exposure to radiation was seven minutes and the patients had two transesophageal echocardiography done during the procedure. One patient had to be taken to open commissurotomy due to perforation of the aorta which caused minimal hematoma. In two patients transient fetal bradycardias were noted during the hypotensive episodes caused by balloon inflation with no serious fetal distress. All but one pregnancies got to term; four patients delivered vaginally and three underwent cesarean section due to obstetric indication. Neonatal weight and Apgar score were satisfactory. We consider that the significative benefits of the procedure, together with zero maternal and fetal mortality make this technique an acceptable one for this pathology.