A primigravida at 30 weeks has mitral stenosis (MVA 0.9 cm²) with NYHA Class III symptoms despite medical therapy. The safest intervention in pregnancy is:

• A Open mitral valve commissurotomy (OMVC) under cardiopulmonary bypass
• B Mitral valve replacement with a bioprosthetic valve
• C Balloon mitral valvuloplasty (BMV) under fluoroscopic guidance with lead shielding ✓
• D Early cesarean section at 32 weeks to permit cardiac intervention

Explanation

Percutaneous balloon mitral valvuloplasty (BMV/PTMC) is the intervention of choice for severe mitral stenosis with refractory symptoms during pregnancy, provided anatomy is favorable (Wilkins score ≤8, minimal MR, no LA thrombus). It can be performed safely under fluoroscopy with abdominal lead shielding to minimize fetal radiation. Open cardiac surgery on cardiopulmonary bypass carries 20–30% fetal mortality risk and is reserved for BMV failure. Mitral valve replacement with bioprosthesis requires anticoagulation challenges. Early delivery does not address maternal hemodynamic compromise.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.