A 28-year-old primigravida at 20 weeks has rheumatic mitral stenosis with valve area 0.9 cm², NYHA Class III symptoms, and pulmonary artery systolic pressure 55 mmHg on echocardiography. The most appropriate intervention is:

• A Percutaneous balloon mitral valvuloplasty (PBMV) under fluoroscopy with abdominal shielding ✓
• B Emergency caesarean section to relieve haemodynamic stress
• C Closed mitral valvotomy under cardiopulmonary bypass
• D Metoprolol and diuretics alone; intervention deferred to postpartum period

Explanation

Severe mitral stenosis (valve area <1.0 cm²) with NYHA Class III–IV symptoms and pulmonary hypertension in pregnancy unresponsive to medical therapy requires intervention. Percutaneous balloon mitral valvuloplasty (PBMV) is the procedure of choice during pregnancy as it avoids cardiopulmonary bypass (which carries 20–30% fetal loss risk). PBMV is performed ideally after the 1st trimester with abdominal radiation shielding. Success rates and outcomes in pregnancy are similar to non-pregnant patients. Medical therapy alone is insufficient for NYHA Class III with pulmonary hypertension.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.