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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Stages of mitral stenosis

Stages of mitral stenosis
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
  • *
  • 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
  • *
  • Decreased exercise tolerance
  • Exertional dyspnea
The transmitral mean pressure gradient should be obtained to further determine the hemodynamic effect of the MS and is usually >5 to 10 mmHg in severe MS; however, due to the variability of the mean pressure gradient with heart rate and forward flow, it has not been included in the criteria for severity. This table has been reprinted, nearly unchanged, in the 2020 ACC/AHA guideline for the management of patients with valvular heart disease.

ACC: American College of Cardiology; AHA: American Heart Association; LA: left atrial; LV: left ventricular; MS: mitral stenosis; MVA: mitral valve area; PASP: pulmonary artery systolic pressure.

* As noted in the 2020 ACC/AHA valve guidelines, a PASP >50 mmHg is one of the hemodynamic consequences of severe MS (asymptomatic or symptomatic).
Original table modified for this publication. Reproduced from: Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57. Table used with the permission of Elsevier Inc. All rights reserved.
Graphic 97546 Version 4.0

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