Mitral stenosis treatment overview: Difference between revisions
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{{Family tree | H01 | | H02 | | H03 | | H04 | | | | H05 | | | | | H06 | | H07 | | H08 | H01= Periodic monitoring| H02= [[PMBC]] (Class IIa)| H03= [[PMBC]] (Class I)| H04= Mitral valve surgery (Class I)| H05= [[PMBC]] (Class IIb)| H06= Periodic monitoring| H07= [[PMBC]] (Class IIb)| H08= Periodic monitoring}} | {{Family tree | H01 | | H02 | | H03 | | H04 | | | | H05 | | | | | H06 | | H07 | | H08 | H01= Periodic monitoring| H02= [[PMBC]] (Class IIa)| H03= [[PMBC]] (Class I)| H04= Mitral valve surgery (Class I)| H05= [[PMBC]] (Class IIb)| H06= Periodic monitoring| H07= [[PMBC]] (Class IIb)| H08= Periodic monitoring}} | ||
{{Familytree/end}} | {{Familytree/end}} | ||
==References== | |||
{{Reflist|2}} | |||
[[Category:Valvular heart disease]] | |||
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[[Category:Cardiac surgery]] | |||
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Revision as of 16:56, 12 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
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.[1]
Abbreviations: AF: atrial fibrillation; MR: mitral regurgitation; MS: mitral stenosis; MVA: mitral valve area ; PCWP: pulmonary capillary wedge pressure; PMBC: percutaneous mitral balloon commissurotomy; T1/2: 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Is there a new onset of AF? | Order an exercise treadmill test | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | Yes | No | Yes | No | Is PCWP> 25 mm Hg? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.