Mitral Stenosis surgical indications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Hemodynamic and Clinical Outcomes

• Results of the commissurotomy should be assessed with hemodynamics and echocardiography
• If second inflation is needed mitral regurgitation should be assessed
• In general increasing valve area to greater than 1 cm2/m2 is an acceptable result
• Usually the valve area doubles and the pulmonary pressures degrease immediately
• 5 year survival is in the 90% range

Factors favouring successful percutaneous mitral valvuloplasty

Mitral stenosis is amenable to percutaneous mitral valvuloplasty if the echocardiography demonstrates :

• Thickening confined to valve tips
• Good mobility of Anterior mitral valve leaflet
• Little chordal involvement
• not more than trivial mitral regurgitation
• no left atrial thrombus
• no commissural calcification.

Wilkins score

A scoring system exists to grade the morphological changes in the mitral valve during assessment with echocardiography. This takes into account 4 characteristics: leaflet mobility, leaflet thickening, valve calcification and involvement of the subvalvular apparatus. The involvement is graded from 0-4. A total score of more than 8 is predictive of a low success post percutaneous mitral valvuloplasty.