Management of severe rheumatic mitral stenosis (MVA ≤1.5 cm²)

All patients with rheumatic mitral stenosis should receive routine follow-up and medical management as indicated including drug therapy (eg, diuretic) for heart failure, management of atrial fibrillation, and anticoagulation as needed.

MVA: mitral valve area; MS: mitral stenosis; PMBC: percutaneous mitral balloon commissurotomy; PASP: pulmonary artery systolic pressure; AF: atrial fibrillation; MR: mitral regurgitation; LA: left atrial; NYHA: New York Heart Association.

* The favorability of mitral valve morphology is based upon multiple valvular and subvalvular features associated with successful PMBC (effective reduction of severity of MS without inducing/worsening MR). Refer to UpToDate content on scoring systems to assess the favorability of mitral valve morphology as well as other criteria for PMBC.

¶ For patients with symptomatic MS with NYHA functional class III or IV who have unfavorable valve anatomy for PMBC but high surgical risk, we suggest PMBC if there are no contraindications. High-risk mitral valve surgery or medical management are reasonable alternatives.

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Management of severe rheumatic mitral stenosis (MVA ≤1.5 cm2)

Management of severe rheumatic mitral stenosis (MVA ≤1.5 cm²)