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PMBC for Rheumatic MS — EECC MCQ

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ModerateValvular Heart DiseasePMBC for Rheumatic MSEECC

A 60-year-old woman with a history of rheumatic fever has moderate mitral stenosis (MVA 1.3 cm²) with pliable leaflets, minimal calcification, no MR, and no LA thrombus. She develops new-onset AF with a rapid ventricular response and becomes symptomatic (NYHA III). What is the preferred intervention?

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Correct answer: B — Percutaneous mitral balloon commissurotomy (PMBC) if the Wilkins echocardiographic score is ≤8 and there is no more than mild MR

Percutaneous mitral balloon commissurotomy (PMBC) is the treatment of choice for symptomatic rheumatic MS with favourable anatomy. The Wilkins score evaluates 4 echocardiographic features (leaflet mobility, thickening, calcification, subvalvular disease), each scored 1-4 (total 4-16). A score ≤8 predicts excellent PMBC outcomes. Additional prerequisites: no more than mild MR, no LA thrombus (requires TOE before procedure). The 2025 ESC VHD Guidelines recommend PMBC for symptomatic MS (MVA ≤1.5 cm²) with favourable anatomy (Class I). For unfavourable anatomy (heavy calcification, significant subvalvular fusion, moderate+ MR), surgical MVR or repair is preferred.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease