A pregnant woman with rheumatic mitral stenosis (valve area 1.0 cm², symptomatic at 24 weeks, NYHA III) is on beta-blockers. Despite optimal medical therapy her symptoms worsen at 28 weeks. The MOST appropriate intervention is:
- A Emergency mitral valve replacement with a mechanical prosthesis
- B Percutaneous balloon mitral valvuloplasty (PBMV) under fluoroscopic guidance ✓
- C Elective cesarean section at 32 weeks
- D Diuretic therapy and admission with continued conservative management
Explanation
PBMV (Inoue balloon technique) is the intervention of choice for severe symptomatic mitral stenosis in pregnancy when medical therapy fails, particularly between 20–30 weeks when maternal risk peaks. It is performed with lead shielding to minimise fetal radiation exposure. Open heart surgery with cardiopulmonary bypass carries a 20–30% fetal mortality risk and is reserved for failure of PBMV or valve unsuitable for valvuloplasty. Elective preterm delivery at 32 weeks does not address the maternal cardiac compromise. Continued conservative management alone is insufficient in NYHA III despite optimal medical therapy.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.