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. ↓ 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. ↓ 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