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Normal gestation is associated with a hyperdynamic adaptive state. The circulatory changes represent an additional burden on the cardiovascular system of women with rheumatic mitral stenosis (MS). Life-threatening complications can occur in pregnant women with severe MS. We successfully performed percutaneous balloon mitral valvotomy (PMV) in eight pregnant patients (mean age 28±6·9 years, range 21–38 years). Pregnancy mean age was 24·6±6·5 weeks. Five patients were in NYHA functional class III and three patients were in class IV. Emergency PMV seemed to be life saving to both mother and foetus in one case. All patients but one had pliable valves. PMV was achieved using the double balloon transseptal technique. To protect the foetus from radiation, the patient's pelvic-abdominal area was shielded and left ventriculography was not performed. The total mean time of PM V was 72±19 min and that offluoroscopy was 16·6±7·8 min. Gorlin's mitral valve area increased from 0·83±0·15 to 2·4±0·34 cm and the cardiac index from 3·1 ±0·77 to 4·2 ±0·791. min−1. m−2. Left atrium pressure decreased from 29±10 to 14 ±5 mmHg and mitral valve gradient from 21±7 to 6±3 mmHg. There were no complications or residual MS. At a mean follow-up of 13·2±9·4 months, all patients were in NYHA class I and had a normal course of pregnancy. The eight women delivered healthy full-term babies. At 1–25 months post-partum follow-up, the eight infants had shown normal growth and development. PMV can be the treatment of choice for the management of pregnant women with severe MS and disability. [ABSTRACT FROM PUBLISHER]