A pregnant woman at 28 weeks with rheumatic heart disease (severe mitral stenosis, MVA 0.8 cm²) develops progressive dyspnoea with resting O₂ saturation 91%. She is in sinus rhythm. What is the MOST appropriate intervention?

• A Elective caesarean section at 34 weeks
• B Medical management with diuretics and beta-blockers until 37 weeks
• C Open mitral commissurotomy under cardiopulmonary bypass
• D Percutaneous balloon mitral valvotomy (PBMV) ✓

Explanation

Severe symptomatic mitral stenosis in pregnancy (MVA <1.0 cm², refractory to medical therapy) carries high maternal and fetal mortality. PBMV is the intervention of choice in pregnancy because it avoids cardiopulmonary bypass (which carries fetal risk), and can be performed with adequate lead shielding to minimize fetal radiation. It has excellent results with suitable valve morphology (Wilkins score ≤8). Open commissurotomy on cardiopulmonary bypass is reserved for failed or unsuitable PBMV.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.