In heart patient the worst prognosis during pregnancy is seen in:
Mitral regurgitation
Mitral valve prolapse
Aortic stenosis
Pulmonary stenosis
Remember 3 ‘FUNDAS: Highest maternal mortality is associated with Class III of clarkes cl;assification, so any of those diseases are given they will have the worst prognosis. Amongst them also Eisenmengers syndrome has the worst prognosis.
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2. Stenotic heart disease have a worse prognosis than regurgitant lesions.
Among stenotic disease-(in alphabetical order)-Aortic stenosiswill have the worst> Mitral stenosis>Pulmonary stenosis.
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3. Congenital heart disease and Mitral valve prolapse have the best prognosis
So now this question becomes very easy-Mitarl vave prolapse has the best prognosis, so it is ruled out; Regurgitant lesions have a better prognosis than stenotic lesions so mitral regurgitation is also ruled out. Now we are left with 2 options, aortic stenosis and pulmonary stenosis-as I said go alphabetically, aortic stenosis will have a worse prognosis than pulmonary.
Let’s consider each of the options one by one and see what Williams has to say about each of them.
Option “a” Mitral regurgitation
“M R is well-tolerated during pregnancy probably due to decreased systemic vascular resistance which actually results in less regurgitation. Heart failure only rarely develops during pregnany.”
Williams Obs. 22/e, p 1026, 23/e, p 966
Option “b” Mitral valve prolapse
“Pregnant women with mitral valve prolapse rarely have cardiac complications. In fact pregnancy induced hypervolemia may improve alignment of mitral valve.”
Williams Obs. 22/e, p 1030, 23/e, p 971
Option “c” Aortic stenosis
“Although mild to moderate degree of aortic stenosis is well tolerated but severe degree is life threatening.”
Williams Obs. 22/e, p 1026, 23/e, p 967
Option “d” Pulmonary stenosis
“It is well tolerated during pregnancy and rarely causes any complication.”
Williams Obs. 22/e, p 1027, 23/e, p 968