A 35-year-old woman with known rheumatic mitral stenosis (MVA 0.9 cm²) presents at 28 weeks with worsening dyspnoea (NYHA Class III). She is in sinus rhythm. Which statement best reflects current management?
- A Closed mitral valvotomy is the only safe surgical option in pregnancy
- B Immediate caesarean section to reduce cardiac load, defer valve repair to postpartum
- C Percutaneous balloon mitral valvuloplasty (PBMV) is the preferred intervention if valve anatomy is suitable ✓
- D Open mitral valve replacement under cardiopulmonary bypass is safe in the second trimester
Correct answer: C. Percutaneous balloon mitral valvuloplasty (PBMV) is the preferred intervention if valve anatomy is suitable
Explanation
Percutaneous balloon mitral valvuloplasty (PBMV) is the preferred intervention for symptomatic severe mitral stenosis in pregnancy when valve anatomy is favourable (Wilkins score 8 or less), performed after 24–26 weeks with abdominal shielding to minimise fetal radiation. Cardiopulmonary bypass carries 20–30% fetal mortality. Immediate cesarean does not address the valve pathology. Closed valvotomy is obsolete.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.