A 45-year-old woman with severe mitral stenosis (MVA 0.8 cm²) is in sinus rhythm, has no LA thrombus, no MR, and minimal valvular calcification. She develops exertional dyspnoea (NYHA class III). The MOST appropriate intervention is:

• A Percutaneous mitral balloon commissurotomy (PMBC) ✓
• B Mitral valve replacement with mechanical prosthesis
• C Surgical mitral valve repair
• D Medical management with beta-blocker and diuretic, defer intervention

Explanation

Per ACC/AHA 2021 and ESC 2021 guidelines, PMBC (percutaneous mitral balloon commissurotomy / Inoue balloon technique) is the procedure of choice for severe symptomatic mitral stenosis when the valve is morphologically favourable (low Wilkins score ≤8: minimal calcification, pliable leaflets, no subvalvular disease) and there is no LA thrombus or significant MR. PMBC yields outcomes equivalent to surgical commissurotomy with lower morbidity. MVA 0.8 cm² is very severe MS. Surgical repair/replacement is reserved for unfavourable morphology or PMBC failure. Class III symptoms mandate intervention.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.