A 30-year-old woman is found to have severe rheumatic mitral stenosis: MVA 0.8 cm², mean gradient 18 mmHg, valve score 6/16 (Wilkins), no MR, no left atrial thrombus on TOE, and NYHA class III symptoms. Pulmonary artery systolic pressure is 58 mmHg. Which intervention is the treatment of choice?

• A Mitral valve replacement (MVR) with mechanical prosthesis
• B Open surgical mitral commissurotomy
• C Medical management with rate control and anticoagulation alone
• D Percutaneous mitral balloon commissurotomy (PTMC) ✓

Explanation

PTMC (percutaneous transvenous mitral commissurotomy) is the treatment of choice for symptomatic severe rheumatic mitral stenosis when valve morphology is suitable (Wilkins score ≤8, pliable non-calcified leaflets, no significant MR, no LA thrombus). A score of 6/16 is ideal for PTMC. It provides results equivalent to surgical commissurotomy in selected patients with lower morbidity. MVR is reserved for patients with unsuitable valve anatomy (high Wilkins score, heavy calcification, significant MR) or failed PTMC.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.