Sandbox Rim

Mitral Stenosis

Determine the severity of 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 appendage clot AND ❑ No or mild MR

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

Is there a new onset of AF?

Order an exercise stress 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 appendage clot AND ❑ No or mild MR

No

Yes

Yes

No

Yes

No

Periodic monitoring

PMBC (Class IIa)

PMBC (Class I)

MVR (Class I)

PMBC (Class IIb)

Periodic monitoring

PMBC (Class IIb)

Periodic monitoring