Methods: We evaluated 12 cases (mean age 28.1±5.4 years; range 19 to 37 years) who required cardiac surgery for mitral valve pathology during pregnancy and assessed preoperative status, maternal and fetal mortality and morbidity. Nine patients with rheumatic mitral stenosis presented with cardiac decompensation refractory to medical treatment. Three patients presented with pulmonary edema due to valve obstruction of mitral prosthesis and underwent emergent rereplacement. Closed mitral commisurotomy (CMC) was performed in seven patients. Two patients with severe mitral valve calcification and concomitant mitral regurgitation required mitral valve replacement. In one of three patients who underwent emergent mitral valve re-replacement for obstructed mitral prosthesis, a bioprosthetic mitral valve was replaced whereas a mechanical valve was replaced in two.

Results: There were neither operative mortality nor cardiac morbidity. All patients who underwent elective CMC gave birth spontaneously at term without any cardiac complications and none of the babies had any problem. Two patients with elective mitral valve replacement delivered healthy babies 10 and 6 weeks after operation. Among the three patients undergoing emergent mitral re-replacement, cesarean section before cardiac operation was performed in one who delivered a healthy baby, and spontaneous abortion occurred in the other two patients on the second postoperative day. Fetal mortality rate was 16.7%. None of patients who underwent closed mitral commisurotomy required reoperation during a mean followup of 37.4 months. One case undergoing mitral re-replacement with a bioprosthesis expired from stroke 11 months after the operation. No other late mortality was observed.

Conclusion: Cardiac operations for mitral valve disease can be performed in pregnant patients with low fetal mortality and without any maternal mortality and morbidity. In patients with eligible mitral valve pathologies, CMC may be an option.