35years old man RECURRENT attake of palpitation

I think the most common caus of mitral valve stenosis is rheumatic heart disease so clinically I think the diagnosis stright forword: a rheumatic heart disease without develpement of faliure,mitral stenosis with atrial fibrillation comlicated with pulmonary hypertention and no signs suggesting SBE.Diagnosis must be confirmed first by CXR ECG and echo and ivestgation for the cause although stenosis occure after many years of rheumatic activityI think the patient is NYHA class 3 or four and both are indication for surgerythe patient must recieve a low dose of diuretis to relief dyspnoea, and for AF digoxin and warfarin as a prophylaxis, some authers advice about antibiotic prophylaxis for SBE