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Radiation-induced Mitral Stenosis — EECC MCQ

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HardValvular Heart DiseaseRadiation-induced Mitral StenosisEECC

A 70-year-old man with severe MS (MVA 0.8 cm²) due to previous mediastinal radiation therapy has significant annular calcification and subvalvular fibrosis. He is NYHA class III. PMBC is considered. Is this appropriate?

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Correct answer: D — PMBC is contraindicated in radiation-induced MS — the mechanism is annular/subvalvular calcification and fibrosis rather than commissural fusion; surgical MVR is the appropriate intervention

Mitral stenosis has different aetiologies requiring different treatment approaches: (1) Rheumatic MS — commissural fusion is the primary mechanism; PMBC works by splitting fused commissures and is highly effective with favourable anatomy (Wilkins score ≤8); (2) Radiation-induced MS — the mechanism is progressive annular and subvalvular calcification with fibrosis, NOT commissural fusion; PMBC is ineffective and potentially harmful (annular rupture risk); (3) MAC-related MS — similar to radiation (annular calcification, not commissural). The 2025 ESC VHD Guidelines differentiate these aetiologies and recommend: PMBC for rheumatic MS with favourable anatomy; surgical MVR for radiation-induced and severely calcified MS. Radiation-induced heart disease also affects other cardiac structures (pericardium, coronary arteries, conduction system), increasing surgical risk.

Reference: ESC/EACTS (2025): VHD Guidelines