A 35-year-old female with mitral stenosis was admitted to hospital in her 23rd week of gestation for management of disabling dyspnea and paroxysmal nocturnal dyspnea. She was in New York Heart Association functional class III and underwent successful percutaneous balloon mitral valvuloplasty with significant improvement of her symptoms. To limit radiation exposure and procedure time, transesophageal echocardiography was used in combination with pulsed fluoroscopy. The remainder of her pregnancy was uncomplicated and she gave birth to a healthy baby at 38 weeks' gestation.