A pregnant woman at 20 weeks is found to have a mitral stenosis with valve area of 1.0 cm² on echocardiography. She is symptomatic despite beta-blocker and diuretic therapy. The best intervention to manage her mitral stenosis during pregnancy is:

• A Closed mitral valvotomy (surgical)
• B Urgent cesarean delivery followed by mitral valve replacement
• C Percutaneous balloon mitral valvuloplasty (PBMV) under fluoroscopic guidance ✓
• D Open heart surgery with cardiopulmonary bypass

Explanation

Percutaneous balloon mitral valvuloplasty (PBMV / Inoue balloon technique) is the preferred intervention for symptomatic severe mitral stenosis (MVA ≤1.0 cm²) refractory to medical therapy during pregnancy. When performed after 20 weeks gestation with shielding of the fetal pelvis, radiation exposure is minimised. It is safer than open heart surgery (which carries 20–30% fetal loss risk). PBMV reliably increases valve area and provides haemodynamic relief until delivery. Closed mitral valvotomy is now largely replaced by PBMV.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.