The treatment of choice is mitral balloon valvuloplasty. Intervention is indicated, as our patient is symptomatic and the lesion is severe. The specific criteria for balloon valvuloplasty present in this patient include relatively thin, pliable mitral valve leaflets, minimally calcified leaflets, minimal thickening and shortening of the chordae tendineae, no significant mitral regurgitation, and no evidence of left atrial thrombus.
The risks and complications of the procedure are low. The results in terms of symptomatic and hemodynamic improvement are comparable to surgical commissurotomy.
If mitral balloon valvuloplasty is unsuccessful or contraindicated, mitral valve surgery is the therapy of choice. Commissurotomy by the closed technique is no longer recommended, open commissurotomy permits more precise valve reconstruction, allowing fused chordae and papillary muscles to be split. Valve replacement has more risk and late complications. It is reserved for patients in whom balloon valvuloplasty or reconstruction are not possible because of valve calcification or associated significant mitral regurgitation.