A pregnant woman with known mitral stenosis (valve area 1.0 cm²) at 28 weeks develops worsening dyspnoea and an episode of paroxysmal nocturnal dyspnoea. Echocardiography confirms severe MS with mean gradient 12 mmHg and pulmonary artery systolic pressure 55 mmHg. She is in sinus rhythm. NYHA class III. Optimal management is:

• A Percutaneous balloon mitral valvuloplasty (PBMV) under fluoroscopy-minimised protocol ✓
• B Urgent caesarean section to deliver the fetus
• C Bed rest, diuretics, beta-blockers, and plan for caesarean at 38 weeks
• D Open mitral valve replacement on cardiopulmonary bypass

Explanation

Severe symptomatic mitral stenosis (valve area < 1.5 cm², NYHA III/IV) that fails medical management in pregnancy is an indication for PBMV (percutaneous balloon mitral valvuloplasty), which can be performed safely in pregnancy with shielding to minimise fetal radiation exposure, preferably after 12 weeks. It is the procedure of choice over open heart surgery on CPB (which carries 20–30% fetal mortality). Caesarean at 28 weeks is premature and does not address the cardiac pathology. Medical management alone is insufficient for NYHA III with severe hemodynamic compromise.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.