Mitral stenosis stages: Difference between revisions
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|style="background:#DCDCDC;"|'''STAGE'''||style="background:#DCDCDC;"|'''DEFINITION'''||style="background:#DCDCDC;"|'''VALVE ANATOMY'''||style="background:#DCDCDC;"|'''VALVE HEMODYNAMICS'''||style="background:#DCDCDC;"|'''HEMODYNAMIC CONSEQUENCES'''||style="background:#DCDCDC;"|'''SYMPTOMS''' | |style="background:#DCDCDC;"|'''STAGE'''||style="background:#DCDCDC;"|'''DEFINITION'''||style="background:#DCDCDC;"|'''VALVE ANATOMY'''||style="background:#DCDCDC;"|'''VALVE HEMODYNAMICS'''||style="background:#DCDCDC;"|'''HEMODYNAMIC CONSEQUENCES'''||style="background:#DCDCDC;"|'''SYMPTOMS''' | ||
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|'''A'''||At risk of [[MS]]||❑ Mild diastolic doming of mitral valve leaflets||❑ Normal transmitral velocity|| | |'''A'''||At risk of [[MS]]||❑ Mild diastolic doming of mitral valve leaflets||❑ Normal transmitral velocity||Absent||Absent | ||
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|'''B'''||Progressive [[MS]]|| ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of [[mitral valve]]<br>❑ [[Mitral valve]] area (MVA) > 1.5 cm<sup>2</sup> (planimetered)||❑ Increased transmitral flow velocities<br>❑ MVA > 1.5 cm<sup>2</sup> <br>❑ Pressure half time during diastole < 150 ms||❑ Mild to moderate left atrial enlargement<br>❑ Normal pulmonary pressure at rest ||None | |'''B'''||Progressive [[MS]]|| ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of [[mitral valve]]<br>❑ [[Mitral valve]] area (MVA) > 1.5 cm<sup>2</sup> (planimetered)||❑ Increased transmitral flow velocities<br>❑ MVA > 1.5 cm<sup>2</sup> <br>❑ Pressure half time during diastole < 150 ms||❑ Mild to moderate left atrial enlargement<br>❑ Normal pulmonary pressure at rest ||None | ||
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|'''C'''||Asymptomatic severe [[MS]]||❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of [[mitral valve]]<br> ❑ MVA ≤ 1.5 cm<sup>2</sup><br>❑ MVA ≤ 1 cm<sup>2</sup> in very severe [[MS]]|| ❑ MVA ≤ 1.5 cm<sup>2</sup> (planimetered)<br>❑ MVA ≤ 1 cm<sup>2</sup> (planimetered) in very severe [[MS]]<br>❑ Diastolic pressure half time ≥ 150 ms<br> ❑ Diastolic pressure half time ≥ 220 ms with very severe [[MS]]||❑ Severe left atrial enlargement<br>❑ PASP > 30 mm Hg|| | |'''C'''||Asymptomatic severe [[MS]]||❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of [[mitral valve]]<br> ❑ MVA ≤ 1.5 cm<sup>2</sup><br>❑ MVA ≤ 1 cm<sup>2</sup> in very severe [[MS]]|| ❑ MVA ≤ 1.5 cm<sup>2</sup> (planimetered)<br>❑ MVA ≤ 1 cm<sup>2</sup> (planimetered) in very severe [[MS]]<br>❑ Diastolic pressure half time ≥ 150 ms<br> ❑ Diastolic pressure half time ≥ 220 ms with very severe [[MS]]||❑ Severe left atrial enlargement<br>❑ PASP > 30 mm Hg||Absent | ||
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|'''D'''||Symptomatic severe [[MS]]||❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of [[mitral valve]]<br> ❑ MVA ≤ 1.5 cm<sup>2</sup> (planimetered)||❑ MVA ≤ 1.5 cm<sup>2</sup><br>❑ MVA ≤ 1 cm<sup>2</sup> in very severe [[MS]]<br>❑ Diastolic pressure half time ≥ 150 ms<br> ❑ Diastolic pressure half time ≥ 220 ms with very severe [[MS]]||❑ Severe left atrial enlargement<br>❑ PASP > 30 mm Hg||❑ [[Dyspnea]] on exertion<br>❑ Decreased exercise tolerance | |'''D'''||Symptomatic severe [[MS]]||❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of [[mitral valve]]<br> ❑ MVA ≤ 1.5 cm<sup>2</sup> (planimetered)||❑ MVA ≤ 1.5 cm<sup>2</sup><br>❑ MVA ≤ 1 cm<sup>2</sup> in very severe [[MS]]<br>❑ Diastolic pressure half time ≥ 150 ms<br> ❑ Diastolic pressure half time ≥ 220 ms with very severe [[MS]]||❑ Severe left atrial enlargement<br>❑ PASP > 30 mm Hg||❑ [[Dyspnea]] on exertion<br>❑ Decreased exercise tolerance |
Revision as of 15:41, 22 July 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Stages of Mitral Stenosis
Shown below is a table depicting 4 stages of mitral stenosis, adapted from 2014 AHA/ACC guidelines for management of valvular heart diseases.[1]
STAGE | DEFINITION | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES | SYMPTOMS |
A | At risk of MS | ❑ Mild diastolic doming of mitral valve leaflets | ❑ Normal transmitral velocity | Absent | Absent |
B | Progressive MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ Mitral valve area (MVA) > 1.5 cm2 (planimetered) |
❑ Increased transmitral flow velocities ❑ MVA > 1.5 cm2 ❑ Pressure half time during diastole < 150 ms |
❑ Mild to moderate left atrial enlargement ❑ Normal pulmonary pressure at rest |
None |
C | Asymptomatic severe MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ MVA ≤ 1.5 cm2 ❑ MVA ≤ 1 cm2 in very severe MS |
❑ MVA ≤ 1.5 cm2 (planimetered) ❑ MVA ≤ 1 cm2 (planimetered) in very severe MS ❑ Diastolic pressure half time ≥ 150 ms ❑ Diastolic pressure half time ≥ 220 ms with very severe MS |
❑ Severe left atrial enlargement ❑ PASP > 30 mm Hg |
Absent |
D | Symptomatic severe MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ MVA ≤ 1.5 cm2 (planimetered) |
❑ MVA ≤ 1.5 cm2 ❑ MVA ≤ 1 cm2 in very severe MS ❑ Diastolic pressure half time ≥ 150 ms ❑ Diastolic pressure half time ≥ 220 ms with very severe MS |
❑ Severe left atrial enlargement ❑ PASP > 30 mm Hg |
❑ Dyspnea on exertion ❑ Decreased exercise tolerance |
MS: Mitral stenosis; MVA:Mitral valve area; PASP: Pulmonary artery systolic pressure;
References
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.