| Stage | Definition | Valve anatomy | Valve hemodynamics | Hemodynamic consequences | Symptoms |
| A | At risk of MS | - Mild valve doming during diastole
| Normal transmitral flow velocity | None | None |
| B | Progressive MS | - Rheumatic valve changes with commissural fusion and diastolic doming of the mitral valve leaflets
- Planimetered MVA >1.5 cm2
| - Increased transmitral flow velocities
- MVA >1.5 cm2
- Diastolic pressure half-time <150 ms
| - Mild-to-moderate LA enlargement
- Normal pulmonary pressure at rest
| None |
| C | Asymptomatic, severe MS | - Rheumatic valve changes with commissural fusion and diastolic doming of the mitral valve leaflets
- Planimetered MVA ≤1.5 cm2
- (MVA ≤1 cm2 with very severe MS)
| - MVA ≤1.5 cm2
- (MVA ≤1 cm2 with very severe MS)
- Diastolic pressure half-time ≥150 ms
- (Diastolic pressure half-time ≥220 ms with very severe MS)
| - Severe LA enlargement
- Elevated PASP >30 mmHg
| None |
| D | Symptomatic severe MS | - Rheumatic valve changes with commissural fusion and diastolic doming of the mitral valve leaflets
- Planimetered MVA ≤1.5 cm2
| - MVA ≤1.5 cm2
- (MVA ≤1 cm2 with very severe MS)
- Diastolic pressure half-time ≥150 ms
- (Diastolic pressure half-time ≥220 ms with very severe MS)
| - Severe LA enlargement
- Elevated PASP >30 mmHg
| - Decreased exercise tolerance
- Exertional dyspnea
|
