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Although on the decline in industrialized nations, rheumatic mitral stenosis is still the most commonly encountered valvular lesion in pregnancy. Treatment of pregnant women with mitral stenosis is complicated by the risk that traditional drug and interventional therapies pose to the fetus. The goal of medical therapy in these patients is to reduce heart rate and left atrial pressure, as the dramatic increase in cardiac output associated with pregnancy can more than double the transmitral gradient. In the setting of the symptomatic pregnant patient with severe mitral stenosis who is not responding to, or cannot tolerate, medical therapy, percutaneous balloon valvuloplasty may be indicated.