Case 373 Medical History A 61-year-old male patient, diagnosed as having acute rheumatic heart disease during childhood, initiated progressive exertional dyspnea, requiring hospitalization due to decompensated heart failure. Undergoing treatment with oral anticoagulants. Transthoracic echocardiogram demonstrated severe mitral stenosis, mitral valve area of 0,5cm², mean gradient of 12mmHg and pulmonary hypertension. Block score of 13 points. Image 1: Doppler echocardiogram, parasternal long axis viewImage 2: Doppler echocardiogram, parasternal short axis viewImage 3: A. Doppler echocardiogram, apical four-chamber view; B. Spectral Doppler: continuous wave registration Pergunta:Qual a conduta terapêutica mais indicada para este paciente? Clinical management Percutaneous balloon mitral valvuloplasty Open surgical commissurotomy Valve replacement Time is Up! Time's up
