Mitral stenosis stages
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Staging of mitral stenosis (MS) is of utmost importance because it dictates the appropriate management plan for the affected patients. The stages of MS are determined based on the valve morphology, the valve hemodynamics characteristics, the consequences of MS on the left atrium and the pulmonary arterial system, and on the presence or absence of symptoms.[1]
Stages of Mitral Stenosis
Shown below is a table depicting the 4 stages of mitral stenosis, adapted from 2014 AHA/ACC guidelines for management of valvular heart diseases.[1]
Abbreviations: MS: mitral stenosis; MVA: mitral valve area; PASP: pulmonary artery systolic pressure
| 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 |
References
- ↑ 1.0 1.1 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.