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Rheumatic MS PMBC — RACP Adult Medicine MCQ

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ModerateCardiologyRheumatic MS PMBCRACP Adult Medicine

A 40-year-old woman with a history of rheumatic fever presents with progressive dyspnoea and AF. She has a low-pitched rumbling mid-diastolic murmur at the apex with an opening snap. Echo shows severe mitral stenosis (MVA 0.9 cm², mean gradient 15 mmHg) with pliable leaflets, minimal calcification, and no significant MR. PASP is 55 mmHg. What is the most appropriate intervention?

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Correct answer: B — Percutaneous mitral balloon commissurotomy (PMBC)

Severe symptomatic rheumatic MS (MVA <1.0 cm²) with favourable valve morphology (pliable leaflets, minimal calcification, no significant MR — Wilkins score ≤8) is ideal for percutaneous mitral balloon commissurotomy (PMBC). PMBC splits the fused commissures with excellent results (MVA doubles, gradient halves). Contraindications: left atrial thrombus (must exclude with TOE), moderate-severe MR, heavy calcification. AF requires anticoagulation.

Reference: CSANZ – 2024 – VHD; ESC 2021 VHD