Mitral stenosis treatment overview

Mitral Stenosis Microchapters
Home
Patient Information
Overview
Pathophysiology
Causes
Differentiating Mitral Stenosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Stages
History and Symptoms
Physical Examination
Electrocardiogram
Chest X Ray
Echocardiography
Cardiac MRI
Cardiac Catheterization
Treatment
Overview
Medical Therapy
Percutaneous Mitral Balloon Commissurotomy (PMBC)
Surgery
Follow Up
Prevention
Case Studies
Case #1
Mitral stenosis treatment overview On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Mitral stenosis treatment overview All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA onMitral stenosis treatment overview
CDC on Mitral stenosis treatment overview
Mitral stenosis treatment overview in the news
Blogs on Mitral stenosis treatment overview
Directions to Hospitals Treating Mitral Stenosis
Risk calculators and risk factors for Mitral stenosis treatment overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Medical therapy for mitral stenosis includes anticoagulation and rate control in patients with atrial fibrillation. Medical therapy can relieve symptoms, but the patient may need surgery to relieve the blood flow obstruction by mitral stenosis. The interventional and surgical treatments for mitral stenosis include: percutaneous mitral balloon valvotomy (PMBV), closed commissurotomy, open commissurotomy (valve repair), and mitral valve replacement.

Treatment Algorithm

Shown below is an algorithm depicting the indications for mitral stenosis intervention according to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease.

Abbreviations: AF: atrial fibrillation; MR: mitral regurgitation; MS: mitral stenosis; MVA: mitral valve area ; PCWP: pulmonary capillary wedge pressure; PMBC: percutaneous mitral balloon commissurotomy; T_1/2: pressure half-time

Determine the severity of rheumatic mitral stenosis (MS)

Very severe MS ❑ MVA ≤1 cm2 ❑ T1/2 ≥220 ms

Severe MS ❑ MVA ≤1.5 cm2 ❑ T1/2 ≥150 ms

Progressive MS MVA >1.5 cm2 T1/2 <150 ms

Is the patient symptomatic?

Is the patient symptomatic?

Is the patient symptomatic?

No ( Stage C)

Yes (Stage D)

No (Stage C)

Yes With no other cause for the symptoms

Does the patient have: ❑ Favorable valve morphology AND ❑ No left atrial clot AND ❑ No or mild MR

Does the patient have: ❑ Favorable valve morphology AND ❑ No left atrial clot AND ❑ No or mild MR

Is there a new onset of AF?

Order an exercise treadmill test

No

Yes

Yes

No

Yes

No

Is PCWP> 25 mm Hg?

Does the patient have: ❑ NYHA class III-IV symptoms AND ❑ High surgical risk

Does the patient have: ❑ Favorable valve morphology AND ❑ No left atrial clot AND ❑ No or mild MR

No

Yes

Yes

No

Yes

No

Periodic monitoring

PMBC (Class IIa)

PMBC (Class I)

Mitral valve surgery (Class I)

PMBC (Class IIb)

Periodic monitoring

PMBC (Class IIb)

Periodic monitoring