27th July 2020

You are reviewing a 10-year-old girl with a history of rheumatic fever who has presented with acute heart failure

You are reviewing a 10-year-old girl with a history of rheumatic fever who has presented with acute heart failure, and a murmur heard loudest in the mitral region. She does not improve with diuretics, digoxin, ace inhibitors and continues to deteriorate. What is the most appropriate next step in management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.