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Percutaneous transluminal mitral commissurotomy (PTMC) is the procedure of choice for the treatment of severe mitral stenosis in symptomatic patients. In recent years, epidemiological changes among these patients are observed, since they more frequently are older, with several comorbidities and unfavorable mitral anatomy, all features that may contraindicate PTMC. Notwithstanding this, high rates of success and safety are achieved, following improvements in the learning curve and technique. We report the case of a 68-year-old Caucasian male, affected by chronic obstructive pulmonary disease and congenital kyphoscoliosis, admitted for acute pulmonary edema in severe mitral valve stenosis and moderate mitral regurgitation. PTMC was performed successfully, without any complications, using few simple tricks.

The authors present a case of diastematomyelia, a malformation of the neurospinal axis, frequently associated with congenital vertebral deformities. Often asymptomatic, its site different from that of the vertebral deformity, it may go unrecognized if specific imaging diagnosis is not used, thus exposing the patient who is then submitted to surgery for the correction of vertebral deformity to a high risk of neurological complications.

The authors describe a case report of a patient affected by congenital thoraco-lumbar scoliosis of a severe degree, aged 32, para 0, gravida 1. She was submitted to orthopedic surgery in childhood. Cesarean section was performed at the 37th week of amenorrhoea. Pregnancy in severe defects of the spine, though becoming more and more uncommon, can still be encountered. Severe congenital scoliosis is a clinical problem; it affects not only the size and shape of the pelvis, but also sometimes results in significant maternal cardiovascular and respiratory complication. The authors, reviewing the literature, evaluate the anatomical and functional (from a biomechanical point of view) derangement of the pelvis, the problem of vaginal delivery and the clinical and radiological assessment of the problem, especially evaluating the cardio-pulmonary function. In conclusion, pregnancy in patients with severe scoliosis can be managed successfully by close monitoring especially of the respiratory function. The decision of the route of delivery is related to clinical assessment and obstetric indications.