A 25-year-old primigravida, who is in the first trimester of pregnancy, reports to the Emergency Room with shortness of breath, cough and chest pain. Her chest examination reveals that her lungs are unremarkable, whereas she has signs of mitral stenosis on cardiac auscultation. Consider the following statements :
1. Doppler echocardiography will provide definitive evaluation of the mitral stenosis.
2. The treatment of choice is balloon valvuloplasty or mitral valvotomy or mitral valve replacement.
3. She requires oral anticoagulants.
4. She only requires anti-failure measures.
Which of the statements given above is/are correct?

Question

A 25-year-old primigravida, who is in the first trimester of pregnancy, reports to the Emergency Room with shortness of breath, cough and chest pain. Her chest examination reveals that her lungs are unremarkable, whereas she has signs of mitral stenosis on cardiac auscultation. Consider the following statements :

1. Doppler echocardiography will provide definitive evaluation of the mitral stenosis.

2. The treatment of choice is balloon valvuloplasty or mitral valvotomy or mitral valve replacement.

3. She requires oral anticoagulants.

4. She only requires anti-failure measures.

Which of the statements given above is/are correct?

Prepp Team · Accepted Answer

Mitral Stenosis in Pregnancy: Evaluating Management Statements

This question assesses understanding of diagnosing and managing mitral stenosis (MS) in a pregnant patient.

Statement 1: Doppler Echocardiography Evaluation

Doppler echocardiography is the primary diagnostic tool for evaluating the severity, morphology, and hemodynamic impact of mitral stenosis. It provides quantitative data on valve area, gradients, and diastolic function, making it definitive. Thus, statement 1 is correct.

Statement 2: Treatment Options for Mitral Stenosis

Significant or symptomatic mitral stenosis may require intervention, even during pregnancy. The main options include percutaneous balloon valvuloplasty (often preferred if feasible), surgical mitral valvotomy, or mitral valve replacement. These interventions aim to relieve the obstruction. Thus, statement 2 is correct.

Statement 3: Requirement for Oral Anticoagulants

Anticoagulation is typically indicated for MS only if atrial fibrillation or thromboembolic events are present. Crucially, warfarin (a common oral anticoagulant) is teratogenic, especially in the first trimester. While anticoagulation might be needed, specifying *oral* anticoagulants without qualification is problematic in early pregnancy, where heparin is usually preferred. Thus, statement 3 is generally considered incorrect in this context.

Statement 4: Reliance on Anti-failure Measures

While managing heart failure symptoms (e.g., with diuretics) is important, it does not address the underlying mechanical problem of mitral stenosis. If the stenosis is causing significant symptoms or hemodynamic compromise, solely relying on anti-failure measures is insufficient. Treatment should aim to correct the valve lesion. Thus, statement 4 is incorrect.

Conclusion

Based on the analysis, statements 1 and 2 are correct. Doppler echocardiography provides definitive evaluation, and intervention options like valvuloplasty or valvotomy are appropriate treatments for significant mitral stenosis.