A pregnant woman with known rheumatic heart disease presents at 28 weeks with increasing dyspnea and orthopnea. Echocardiography shows severe mitral stenosis with mitral valve area 0.8 cm². She is classified as New York Heart Association (NYHA) Class III. Which is the MOST appropriate management?
- A Immediate termination of pregnancy
- B Elective cesarean section at 34 weeks with cardiac monitoring
- C Percutaneous balloon mitral valvuloplasty (PBMV) during pregnancy ✓
- D Digoxin and diuretics alone until term
Correct answer: C. Percutaneous balloon mitral valvuloplasty (PBMV) during pregnancy
Explanation
Severe symptomatic mitral stenosis (MVA <1.0 cm², NYHA III-IV) that is refractory to medical therapy in pregnancy is an indication for PBMV, which can be performed safely after the first trimester (ideally 20–26 weeks) with radiation shielding. PBMV improves hemodynamics without the need for cardiopulmonary bypass, which carries high fetal risk. Anticoagulation and beta-blockers to control heart rate are also essential in management. Termination of pregnancy is not indicated with PBMV as a viable intervention.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.