A 28-year-old woman with known mitral stenosis (MVA 1.0 cm²) develops New York Heart Association Class III dyspnoea at 24 weeks. She is in sinus rhythm. The MOST appropriate immediate cardiac intervention is:

• A Closed mitral valvotomy under general anaesthesia
• B Diuretics and bed rest until delivery at 36 weeks
• C Mitral valve replacement with tissue prosthesis
• D Percutaneous balloon mitral commissurotomy (PBMC) ✓

Explanation

PBMC (balloon mitral valvotomy) is the intervention of choice for haemodynamically significant mitral stenosis in pregnancy that fails medical therapy (diuretics, beta-blockers, heart rate control). It can be performed under fluoroscopy with abdominal shielding after 18 weeks. MVA ≤1.5 cm² with NYHA Class III–IV is an indication for intervention. Open heart surgery (valvotomy or replacement) carries 30% fetal mortality and is reserved for PBMC failure.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.