Sandbox Rim

Mitral Stenosis

Abbreviations: AF: atrial fibrillation; MS: mitral stenosis; MR: mitral regurgitation; MVA: ; MVR: ;PCWP: ;PMBC: ;T_1/2:

Determine the severity of mitral stenosis (MS)

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

Severe MS
MVA ≤1.5 cm2
T_1/2 ≥150 ms

Progressive MS
MVA >1.5 cm2
T_1/2 <150 ms

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

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

No

Yes

No

Periodic monitoring

PMBC (Class IIa)

PMBC (Class I)

MVR (Class I)

PMBC (Class IIb)

Periodic monitoring

PMBC (Class IIb)

Periodic monitoring