Clinical question of the week: what are the next management steps for this patient with mitral stenosis?

A 45-year-old female is currently being followed in a cardiology clinic due to a mitral stenosis diagnosed incidentally during a physical exam 5 years ago. The patient was prescribed atenolol 50mg/d despite minimal symptoms, and remained stable during follow up. She returned to her cardiologist for a clinical evaluation complaining of dyspnea on exertion, with a NYHA functional class III. No orthopnea or other symptoms. The patient denied palpitations or any other complaint. On physical examination, no signs of right heart failure (liver, edema, etc.) were noted, and lung auscultation was unremarkable. The ECG demonstrated a normal sinus rhythm, with an enlarged left atrium and a heart rate of 72 bpm. The chest X-ray was unremarkable, and the echocardiogram demonstrated a moderate mitral stenosis with a valve area of 1.2cm2, and a left atrium of 45 mm. No pulmonary artery systolic pressure was not elevated and not other abnormalities were seen. No information on valve aspect or calcifications was available. What is the most appropriate next step in the management of this case?
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: Source Type: forums