Mitral Stenosis Guidlines

Question 1

Mild MS

Answer 1

— MVA>2.5

Question 2

moderate MS

Answer 2

— MVA: >1.5 cm2

— Diastolic pressure half time: <150 ms

Question 3

Severe MS

Answer 3

— MVA <1.5 cm2

— Diastolic pressure half time > 150ms

— PASP >30 mmHg

Question 4

Extremely Severe MS

Answer 4

— MVA <1.0 cm2

— Diastolic pressure half time >220 ms

Question 5

Stage A MS

Answer 5

— At risk

— Mild valve doming in diastole

Question 6

Stage B MS

Answer 6

— Asx mod MS

— Rheumatic valve changes

— Planimetery MVA > 1.5 cm2

— Diast. pres half time < 150ms

— Normal PAP

— mild-mod LA enlargement

Question 7

Stage MS

Answer 7

— Asx severe MS

— Rheumatic valve changes

— Planimetery MVA < 1.5 cm2, very sev < 1cm2

— Diast. pres half time >150ms, very sev >220 ms

— Elevated PAP >30 mmHg

— Severe LA enlargement

Question 8

Stage MS

Answer 8

— Sx severe MS

— Rheumatic valve changes

— Planimetery MVA < 1.5 cm2, very sev < 1cm2

— Diast. pres half time >150ms, very sev >220 ms

— Elevated PAP >30 mmHg

— Severe LA enlargement

— Decreased Exercis tol, exertional dyspnea

Question 9

MV surgery indications

Class I

Answer 9

— Sev MS + sev Sx (III,IV) (StageD), who are not high risk for surgery and are not candidate or failed PMBV

— sev MS +- Sx (Stage C,D) underg. other cardiac S

Question 10

MV surgery indications

Class IIa

Answer 10

— sev MS + sev Sx (III,IV) (Stage D) provided other operative indications

Question 11

MV surgery indications

Class IIb

Answer 11

— mos, asx MS (Stage B) if undergoing other cardiac surgery

— MV surg+ LAA excision if Severe +-sx (Stage C,D) who had recurrent emboliv events despite on anticoags

Question 12

PMBC

Class I

Answer 12

— Severe, Sx + fav valve morph. + no contraindic.

Question 13

PMBC

Class IIa

Answer 13

— very sev MS, Asx (Stage C) + Fav valve morph + no contraindications

Question 14

PMBC

Class IIb (maybe considered)

Answer 14

— Severe MS, Asx (stage C) + new onset Afib + fav vlav morph _ no contraind

— mod MS, Sx if there is evid. of hemodynamically

significant MS during exercise

— sev MS, sev Sx (III,IV) (Stage D) + suboptimal valv anatomy + not cand for surgery + high risk surgery

Question 15

indications for intervention in Asx MS

Answer 15

– Class I, Sev MS + other cardiac Surg

– Class IIa, PMBC for sev MS + fav + no contr

– Class IIb, PMBC for sev MS + new onset AF

– Class IIb, mod MS + other cardiac surg

– Class IIb, MVS + excison of LAA for sev MS + recurrent embolic events while on adeq anticoag