What is the first-line treatment for symptomatic mitral stenosis in younger patients?

The first-line treatment for symptomatic mitral stenosis in younger patients is percutaneous balloon valvuloplasty. This approach is particularly favorable because it is a less invasive procedure that allows for the dilation of the narrowed mitral valve using a balloon catheter. It is especially suitable for younger patients who may have less severe degenerative changes and a better chance of long-term success from valve preservation.

Balloon valvuloplasty has shown effective outcomes for improving symptoms and hemodynamic status, making it a preferred intervention, as it can alleviate the obstruction without the need for open-heart surgery or valvular replacement. This method is beneficial because it addresses the underlying issue of the narrowed valve while preserving the native mitral valve structure, which is important for younger patients who may have a longer life expectancy and more active lifestyles.

In contrast, open mitral valvotomy and surgical mitral valve replacement are typically reserved for cases where balloon valvuloplasty is not feasible or has failed, or in older patients with more complex disease or specific anatomical considerations. Medical management with diuretics, while useful for symptom control, does not address the structural issue of the stenosis itself and is not considered a definitive treatment. Therefore, percutaneous balloon valvuloplasty stands