Background Rheumatic heart disease is still a major heart problem associated with pregnancy in south China, despite its declining trend. The mortality and morbidity are considerably reduced1 by better perinatal care, where the anesthesiologist plays a major role in the multidisciplinary approach. Nevertheless, in wealthy nation, rheumatic disease has become uncommon and complex congenital heart disease is increasing in the recent decades. With the advent of intensive obstetric and anesthetic care, the death rate of pregnant women with heart disease is lower in mitral stenosis compared with other congenital heart diseases like Eisenmenger’s syndrome, pulmonary vascular obstructive disease and Marfan’s syndrome with aortopathy2. Although mitral stenosis is often associated with mitral regurgitation, morbidity is usually related to mitral stenosis3. Background Rheumatic heart disease is still a major heart problem associated with pregnancy in south China, despite its declining trend. The mortality and morbidity are quite reduced1 by better perinatal care, where the anesthesiologist plays a major role in the multidisciplinary approach. Nevertheless, in wealthy with the advent of intensive obstetric and anesthetic care, the death rate of pregnant women with heart disease is lower in mitral stenosis compared with other congenital heart diseases like Eisenmenger’s syndrome, pulmonary vascular obstructive disease and Marfan’s syndrome with aortopathy 2. Although mitral stenosis is often associated with mitral regurgitation, morbidity is usually related to mitral stenosis 3.