A pregnant woman with rheumatic mitral stenosis (valve area 1.0 cm²) becomes breathless at 28 weeks despite diuretics and beta-blockers. Heart rate is 110 bpm in sinus rhythm. What is the most appropriate intervention?
- A Immediate cesarean section
- B Percutaneous balloon mitral valvuloplasty (PBMV) ✓
- C Add digoxin to control heart rate
- D Mitral valve replacement surgery
Correct answer: B. Percutaneous balloon mitral valvuloplasty (PBMV)
Explanation
Severe mitral stenosis (MVA <1.5 cm²) with decompensation during pregnancy — unresponsive to medical therapy — is best treated by percutaneous balloon mitral valvuloplasty (PBMV), which can be performed safely in pregnancy (ideally after 16 weeks with abdominal shielding) without the teratogenic and cardiopulmonary bypass risks of open surgery. PBMV at experienced centres has outcomes comparable to the non-pregnant population. Caesarean section at 28 weeks is premature and does not treat the valve lesion. Digoxin alone does not address the mechanical obstruction.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.