Rheumatic Mitral Stenosis in Pregnancy

You are the anaesthetist in the multidisciplinary high risk obstetric clinic at a tertiary referral hospital. You are reviewing a 29-year-old woman with rheumatic mitral stenosis who is 20 weeks pregnant with her first child. (G1P0) Medications Bisoprolol 2.5 mg once daily Enoxaparin 80 mg SCI bd (previously on warfarin) Her echocardiogram done earlier in the day is available for review. Transthoracic Echocardiogram Report Height (cm) 165 Weight (kg) 80 BSA (m2) 1.9 Heart Rate 80 bpm Rhythm Sinus LV: LVIDd 4.9 cm (3.9-5.3 cm), LVIDs 3.3 cm (2.3-3.8 cm), EF 55% (> 55%) RV: Mildly dilated, normal systolic function LA: 70 mL/m2 (<35ml/m2), Spontaneous echo contrast RA: 35 mL/m2 (<27ml/m2) AV: Trileaflet valve with normal morphology, No evidence of aortic regurgitation MV: Thickened leaflets. Doming of the anterior leaflet. Restriction of the posterior leaflet. Mean gradient 9 mmHg. MVA 1.5 cm2 TV: Normal morphology, Estimated PASP 40 mmHg