A pregnant woman with rheumatic heart disease (mitral stenosis, MVA 1.0 cm²) is in NYHA Class III at 30 weeks gestation. Which statement regarding management is MOST accurate?
- A Percutaneous balloon mitral valvuloplasty (PBMV) is absolutely contraindicated during pregnancy
- B Beta-blockers are contraindicated in pregnancy and should be replaced by digoxin for rate control
- C PBMV can be performed during pregnancy for severe symptomatic mitral stenosis after 16 weeks with radiation shielding ✓
- D Immediate mitral valve replacement is the treatment of choice for NYHA Class III MS in pregnancy
Correct answer: C. PBMV can be performed during pregnancy for severe symptomatic mitral stenosis after 16 weeks with radiation shielding
Explanation
Percutaneous balloon mitral valvuloplasty (PBMV) is the preferred intervention for severe symptomatic mitral stenosis (MVA < 1.5 cm², NYHA III–IV) in pregnancy when medical therapy fails. It is performed after 16 weeks (to minimise teratogenic radiation risk), with lead shielding of the abdomen. Beta-blockers are actually used in pregnancy for rate control in MS (e.g., metoprolol) and are safe. Open cardiac surgery carries a fetal mortality of 15–30% and is reserved only when catheter-based intervention is not feasible.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.