A 25-year-old with rheumatic mitral stenosis (MVA 0.8 cm²) presents at 22 weeks with dyspnoea and pulmonary oedema. Percutaneous transvenous mitral commissurotomy (PTMC) is considered. What is the key radiation dose reduction strategy when performing PTMC in pregnancy under current guidance?
- A Perform PTMC under echocardiographic guidance only (echo-guided PTMC) to eliminate fluoroscopy exposure ✓
- B Postpone PTMC until 28 weeks when organogenesis is complete
- C Use lead shielding of maternal abdomen and limit fluoroscopy to 5 minutes total
- D PTMC is absolutely contraindicated in pregnancy; medical management only
Explanation
For severe symptomatic mitral stenosis in pregnancy unresponsive to medical therapy, PTMC is the intervention of choice and can be safely performed in the second trimester. The preferred technique to minimize fetal radiation exposure is echocardiography-guided PTMC (using TEE or ICE), which eliminates fluoroscopy entirely. Several centres have reported successful echo-guided PTMC with zero fluoroscopy in pregnancy, offering near-zero fetal radiation. Lead shielding reduces but does not eliminate scatter radiation. PTMC is not contraindicated in pregnancy and is preferred over surgical commissurotomy.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.