A 28-year-old woman with rheumatic mitral stenosis (MVA 1.0 cm²) becomes pregnant. She develops dyspnea at rest at 28 weeks. Medications include beta-blocker. The MOST appropriate intervention at this stage is:

• A Percutaneous balloon mitral valvuloplasty (PBMV) ✓
• B Emergency cesarean section
• C Mitral valve replacement under cardiopulmonary bypass
• D Diuretic therapy alone and await delivery at 37 weeks

Explanation

Severe mitral stenosis (MVA ≤1.0 cm²) with NYHA Class III–IV symptoms during pregnancy is a serious condition with high maternal mortality. When medical management (diuretics, beta-blockers, rate control) fails, percutaneous balloon mitral valvuloplasty (PBMV) is the intervention of choice during pregnancy as it avoids cardiopulmonary bypass, which carries 20–30% fetal mortality. PBMV has excellent results in pliable, non-calcified valves (Wilkins score ≤8). Mitral valve replacement requires bypass and is reserved for failed PBMV or calcified valves.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.