{ "schemaVersion": 2, "eyebrow": "Cardiology", "title": "Mitral Stenosis", "summary": "Mitral stenosis management hinges on confirming hemodynamic severity, distinguishing rheumatic from calcific anatomy, preventing embolism in atrial fibrillation, and selecting balloon commissurotomy only when rheumatic valve morphology and regurgitation permit durable relief.", "seoDescription": "Point-of-care management of mitral stenosis: echocardiographic severity, rheumatic versus calcific anatomy, anticoagulation, and intervention selection.", "clinicalQuestion": "How should physicians assess and manage rheumatic and calcific mitral stenosis, including anticoagulation and valve intervention?", "specialty": "Cardiology", "audience": "U.S. physicians and medical trainees", "tags": [ "mitral stenosis", "rheumatic mitral stenosis", "calcific mitral stenosis", "percutaneous mitral balloon commissurotomy", "mitral valve area", "atrial fibrillation anticoagulation" ], "keyTakeaways": [ "Define severe mitral stenosis by mitral valve area of 1.5 cm2 or less; interpret the mean transmitral gradient in the context of flow and heart rate because gradients vary substantially at the same valve area. [21]", "For rheumatic mitral stenosis with atrial fibrillation, use a vitamin K antagonist rather than a direct oral anticoagulant; a target INR of 2.5 is recommended in the cited management review. [1][2][17]", "Percutaneous mitral balloon commissurotomy is the preferred less-invasive intervention for symptomatic severe rheumatic mitral stenosis when valve morphology is favorable and mitral regurgitation is not grade 3 or 4. [16][18]", "Do not apply rheumatic intervention thresholds indiscriminately to mitral annular calcification: calcific mitral stenosis is high risk for intervention and should generally be treated invasively only in highly symptomatic patients. [2]", "Refer patients with severe valve disease being considered for intervention to a multidisciplinary Heart Valve Team or Primary/Comprehensive Valve Center. [2]" ], "sections": [ { "id": "confirm-severity-and-mechanism", "eyebrow": "Initial evaluation", "heading": "Confirm obstruction and establish rheumatic versus calcific anatomy", "intro": "Transthoracic echocardiography should establish valve area, gradient, consequences, and intervention-relevant morphology.", "paragraphs": [ "Classify severe mitral stenosis when mitral valve area (MVA) is 1.5 cm2 or less. Obtain MVA by direct planimetry when feasible and calculate pressure half-time from the continuous-wave Doppler mitral inflow signal; both are commonly used approaches. [8][9][21]", "Do not use mean transmitral gradient as a stand-alone severity measure. At an MVA of 1.5 cm2 or less, mean gradient can vary considerably with hemodynamic profile; document rhythm and heart rate when interpreting a low or high gradient against the anatomic valve area. [21]", "The etiologic distinction changes the procedural pathway. Rheumatic disease is the anatomy for which percutaneous mitral balloon commissurotomy (PMBC) is used; favorable features include pliable leaflets and subvalvular apparatus. Calcific mitral stenosis is typically associated with extensive mitral annular calcification, in which planimetry may be inaccurate and abnormal left atrial and left ventricular compliance can produce a high gradient without severe anatomic obstruction. [2][16]" ], "bullets": [ "For rheumatic disease, document leaflet and subchordal pliability and mitral regurgitation grade before selecting PMBC. [16]", "For calcific disease, reconcile MVA with Doppler gradient and chamber compliance rather than treating a gradient alone as proof of severe obstruction. [2]" ], "subsections": [], "table": { "caption": "Echocardiographic findings that direct the mitral stenosis pathway. [2][8][9][16][21]", "columns": [ "Finding", "Interpretation", "Action changed" ], "rows": [ [ "MVA ≤1.5 cm2", "Severe mitral stenosis. [21]", "Determine symptom burden, rhythm, pulmonary consequences, and candidacy for intervention. [2][16]" ], [ "Discordant MVA and mean gradient", "Gradient is flow- and hemodynamic-profile dependent. [21]", "Review heart rate, rhythm, valve anatomy, and left-sided compliance before labeling severity. [2][21]" ], [ "Pliable rheumatic leaflets/subvalvular apparatus", "Favorable PMBC morphology. [16]", "Consider PMBC when severe disease is symptomatic and regurgitation is acceptable. [16][18]" ], [ "Extensive mitral annular calcification", "Planimetry may be inaccurate; compliance abnormalities may elevate gradient without severe obstruction. [2]", "Avoid extrapolating rheumatic PMBC indications; consider intervention only for highly symptomatic patients at an expert valve center. [2]" ] ] } }, { "id": "manage-symptomatic-rheumatic-ms", "eyebrow": "Definitive treatment", "heading": "Select balloon commissurotomy or surgery for rheumatic mitral stenosis", "intro": "Anatomy and mitral regurgitation determine whether a catheter-based commissural procedure is appropriate.", "paragraphs": [ "For symptomatic severe rheumatic mitral stenosis, select PMBC when valve morphology is favorable. The cited criteria emphasize pliability of the leaflets and subchordal apparatus and absence of grade 3 or 4 mitral regurgitation; this approach achieves results similar to surgical valvotomy with less trauma and scarring in the randomized-trial evidence summarized by NICE. [16][18]", "When the rheumatic valve is unsuitable for PMBC because morphology is unfavorable or regurgitation is grade 3 or 4, pursue surgical evaluation rather than forcing balloon intervention. Surgical treatment is advised for severe mitral stenosis when morphology is not favorable for PMBC. [16]", "Send every patient with severe mitral stenosis being considered for intervention to a multidisciplinary team or Primary/Comprehensive Valve Center. This is particularly important when concomitant valve disease, advanced age, extensive calcification, or major comorbidity makes the procedural risk-benefit assessment nonstandard. [2]" ], "bullets": [ "PMBC is a rheumatic-valve strategy; do not infer suitability from MVA alone. [16]", "Grade 3 or 4 mitral regurgitation is an unfavorable feature for PMBC selection. [16]", "Use surgery when severe rheumatic disease requires intervention but PMBC anatomy is unfavorable. [16]" ], "subsections": [], "table": { "caption": "Intervention selection in severe mitral stenosis. [2][16][18]", "columns": [ "Clinical branch", "Preferred next step", "Key exclusion or tradeoff" ], "rows": [ [ "Symptomatic severe rheumatic MS with pliable valve/subvalvular apparatus and no grade 3 or 4 MR", "PMBC. [16][18]", "Procedure selection depends on morphology, not valve area alone. [16]" ], [ "Severe rheumatic MS with unfavorable PMBC morphology or grade 3 or 4 MR", "Surgical evaluation at a valve center. [16]", "Balloon commissurotomy is not the preferred route when these features are present. [16]" ], [ "Calcific MS with extensive mitral annular calcification", "Reserve intervention for highly symptomatic patients; assess at an experienced valve center. [2]", "Extensive calcification, older age, and comorbidity increase intervention risk; rheumatic thresholds do not directly apply. [2]" ] ] } }, { "id": "prevent-thromboembolism", "eyebrow": "Antithrombotic management", "heading": "Use vitamin K antagonist anticoagulation for atrial fibrillation with rheumatic mitral stenosis", "intro": "Rheumatic mitral stenosis is a specific exclusion from the usual native-valve direct oral anticoagulant pathway.", "paragraphs": [ "In atrial fibrillation with rheumatic mitral stenosis, prescribe oral anticoagulation with a vitamin K antagonist rather than a non-vitamin K oral anticoagulant. ACC/AHA guidance identifies rheumatic mitral stenosis, along with mechanical prostheses, as the exception to CHA2DS2-VASc-based selection of either agent class for other native valve disease. [2][14][17]", "Warfarin is the primary oral anticoagulant option because direct oral anticoagulant trials consistently excluded patients with mitral stenosis. The cited rheumatic mitral stenosis review recommends indefinite therapeutic warfarin with a target INR of 2.5 in the setting of concomitant rheumatic mitral stenosis and embolic risk. [1]", "Do not substitute aspirin for therapeutic anticoagulation when rheumatic mitral stenosis coexists with an embolic indication. Historical cohorts before widespread anticoagulation experienced embolic events in more than 25% of patients during the disease course, supporting the high-risk framing in this population. [1]" ], "bullets": [ "Rheumatic MS plus AF: select a vitamin K antagonist. [2][17]", "Native valve disease other than rheumatic MS with AF: a direct oral anticoagulant may be used according to CHA2DS2-VASc assessment. [2][14]", "A cited target for warfarin in rheumatic MS is INR 2.5. [1]" ], "subsections": [], "table": { "caption": "Anticoagulant selection by valve and rhythm context. [1][2][14][17]", "columns": [ "Clinical context", "Anticoagulant approach", "Decision point" ], "rows": [ [ "Rheumatic MS with AF", "Vitamin K antagonist; cited target INR 2.5. [1][2][17]", "Do not use the usual native-valve DOAC pathway. [2][14]" ], [ "Mechanical prosthesis with AF", "Vitamin K antagonist. [2][17]", "Mechanical prosthesis is also excluded from the DOAC pathway. [2]" ], [ "Native valve disease with AF, excluding rheumatic MS", "Vitamin K antagonist or DOAC based on shared decision-making and CHA2DS2-VASc score. [2][14]", "This exception framework should not be generalized to rheumatic MS. [2]" ] ] } }, { "id": "manage-calcific-ms-and-mixed-valve-disease", "eyebrow": "High-risk anatomy", "heading": "Approach calcific mitral stenosis and concomitant aortic stenosis cautiously", "intro": "Calcific obstruction has different diagnostic limitations and substantially different procedural hazards than rheumatic disease.", "paragraphs": [ "Calcific mitral stenosis should not be managed as rheumatic commissural fusion. Extensive calcification can prevent accurate planimetered area measurement, while left atrial and left ventricular compliance abnormalities can generate a high gradient without severe fixed obstruction. Invasive treatment is therefore limited to patients who are highly symptomatic, with evaluation at an experienced valve center. [2]", "When severe aortic stenosis coexists with mitral stenosis, avoid assuming that mitral intervention should occur first. Treating mitral stenosis first can precipitate severe pulmonary edema by abruptly increasing preload to a small-cavity, low-flow left ventricle downstream from stenotic aortic valve. [5]", "If intervention is pursued in extensive mitral annular calcification, recognize the elevated risk created by calcification, advanced age, and comorbidity. Surgical approaches may require complex annular reconstruction or replacement strategies, and transcatheter approaches are considered in patients who are not surgical candidates; neither pathway is a routine analog of rheumatic PMBC. [2][16][5]" ], "bullets": [ "Concomitant severe AS and MS: determine sequencing in a multidisciplinary valve team because mitral-first treatment can cause pulmonary edema. [5]", "Extensive MAC: reserve procedural treatment for highly symptomatic patients after anatomy and hemodynamics are reconciled. [2]" ], "subsections": [], "table": { "caption": "Management distinctions in rheumatic and calcific mitral stenosis. [2][5][16]", "columns": [ "Feature", "Rheumatic MS", "Calcific MS/MAC" ], "rows": [ [ "Primary procedural option", "PMBC when symptomatic severe disease has favorable morphology and no grade 3 or 4 MR. [16][18]", "No analogous routine balloon pathway; intervention only in highly symptomatic patients. [2]" ], [ "Assessment pitfall", "Procedure suitability requires leaflet, subvalvular, and MR assessment. [16]", "Calcification can impair planimetry; abnormal compliance can elevate gradient without severe obstruction. [2]" ], [ "Risk context", "Escalate to surgery if anatomy is unsuitable for PMBC. [16]", "Extensive calcification, older age, and comorbidity raise intervention risk. [2]" ], [ "Concomitant severe AS", "Not specifically addressed by PMBC criteria. [16]", "Mitral-first treatment may trigger pulmonary edema in low-flow severe AS. [5]" ] ] } }, { "id": "follow-up-and-escalation", "eyebrow": "Follow-through", "heading": "Use symptoms, hemodynamics, rhythm, and anatomy to trigger reassessment", "intro": "Repeat evaluation when clinical status changes rather than relying on a prior gradient or valve-area measurement alone.", "paragraphs": [ "New or worsening exertional limitation, pulmonary congestion, or atrial fibrillation should prompt repeat transthoracic echocardiography with MVA, mean gradient, rhythm, and assessment of left atrial and pulmonary circulatory consequences. ACC/AHA staging integrates valve anatomy, hemodynamics, left atrial and pulmonary effects, and symptoms rather than a single measurement. [3]", "Escalate promptly to a Heart Valve Team when severe disease is symptomatic, when MVA and gradient are discordant, when there is substantial calcification, or when mixed aortic and mitral disease makes sequencing uncertain. A multidisciplinary valve-center review is recommended for severe valve disease under consideration for intervention. [2]", "After PMBC or surgical treatment, reassess the residual stenosis and mitral regurgitation using echocardiographic valve-area methods. In patients after mitral valve repair, pressure half-time may not correlate with mean gradient, so interpret the measurement in the postoperative anatomy rather than using preintervention assumptions. [7]" ], "bullets": [ "Repeat echo after a meaningful change in symptoms, rhythm, or congestion to reassess MVA and gradient in current hemodynamic conditions. [3][21]", "Post-repair: recognize that pressure half-time and mean gradient may diverge. [7]", "Severe disease under consideration for intervention warrants valve-center involvement. [2]" ], "subsections": [], "table": { "caption": "Escalation triggers in mitral stenosis. [2][3][5][7][21]", "columns": [ "Trigger", "Immediate reassessment", "Next action" ], "rows": [ [ "Symptoms out of proportion to prior study", "Repeat echo with MVA, gradient, rhythm, and chamber/pulmonary consequences. [3][21]", "Refer for valve-team review if severe disease or discordance persists. [2]" ], [ "High gradient with extensive MAC", "Reassess anatomic obstruction and compliance-related gradient elevation. [2]", "Restrict intervention consideration to highly symptomatic patients. [2]" ], [ "Severe AS plus MS", "Define each lesion's hemodynamic contribution and procedural sequence. [5]", "Multidisciplinary review; avoid reflex mitral-first treatment. [5]" ], [ "Post-repair discordant pressure half-time and gradient", "Interpret valve area with postoperative anatomy in mind. [7]", "Use comprehensive echocardiographic assessment rather than pressure half-time alone. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Management of rheumatic mitral stenosis", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31779-9/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "**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** _JACC._ 2014; **63**:e57-e185 Before the widespread use of anticoagulation, over 25% of patients with mit", "score": 0.6625569 }, { "number": 2, "title": "2020 ACC/AHA Guideline for the Management of Patients ... - JACC", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2020.11.018", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "3.\n\nFor patients with valvular heart disease and atrial fibrillation (except for patients with rheumatic mitral stenosis or a mechanical prosthesis), the decision to use oral anticoagulation to prevent thromboembolic events, with either a vitamin K antagonist or a non–vitamin K antagonist anticoagul", "score": 0.74652773 }, { "number": 3, "title": "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", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2014.02.537", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "2.\n\nMitral valve repair is reasonable for asymptomatic patients with chronic severe nonrheumatic primary MR (stage C1) and preserved LV function (LVEF >60% and LVESD <40 mm) in whom there is a high likelihood of a successful and durable repair with 1)new onset of AF or 2) resting pulmonary hypertens", "score": 0.7293082 }, { "number": 4, "title": "2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/circulationaha.108.190748", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Aortic valve replacement and coronary bypass grafting for patients with aortic stenosis and coronary artery disease: early and late results. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association T", "score": 0.68064564 }, { "number": 5, "title": "Aortic Valve Disease, Transcatheter Aortic Valve Replacement, and the Heart Failure Patient: A State-of-the-Art Review", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jchf.2023.07.003", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "## References\n\n1.\n\nOtto C.M., Nishimura R.A., Bonow R.O., et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. _J Am Coll Cardiol_. 2021;77:", "score": 0.5518883 }, { "number": 6, "title": "Epidemiology of Valvular Heart Disease in Asia Pacific Region", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacasi.2025.03.011", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "8.\n\nVahanian A., Beyersdorf F., Praz F., et al. ESC/EACTS Scientific Document Group. 202 1 ESC/EACTS Guidelines for the management of valvular heart disease. _Eur Heart J_. 2021;202.\n\nGoogle Scholar\n\n [a [...] paradigm for patients with VHD globally.](\n [b [...] and European](\n [c [...] above ", "score": 0.48191768 }, { "number": 7, "title": "Assessment of Mitral Valve Area During Percutaneous Mitral Valve ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/full/10.1161/circimaging.113.000620?doi=10.1161%2FCIRCIMAGING.113.000620", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Mitral valve area by the pressure half-time method does not correlate with mean gradient in mitral valve repair patients. Eur J Echocardiogr. 2011;12:124–130.", "score": 0.7038554 }, { "number": 8, "title": "Cardiovascular Magnetic Resonance Imaging for Valvular Heart ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circulationaha.107.742486", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "For evaluation of mitral stenosis, 2 methods are commonly used to determine valve area: planimetry and pressure half-time. A trend can be", "score": 0.6543875 }, { "number": 9, "title": "Low‐Gradient Severe Mitral Stenosis: Hemodynamic Profiles ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/JAHA.118.010736", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "MVA was calculated using echocardiographic pressure half‐time (PHT) from the continuous‐wave Doppler signal across the mitral inflow, according", "score": 0.6202772 }, { "number": 10, "title": "The 2020 ACC/AHA Guidelines for Management of Patients With Valvular Heart Disease: Highlights and Perioperative Implications - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1053077021003396", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: The 2020 ACC/AHA Guidelines for Management of Patients With Valvular Heart Disease: Highlights and Perioperative Implications - ScienceDirect\n# Expert Review The 2020 ACC/AHA Guidelines for Management of Patients With Valvular Heart Disease: Highlights and Perioperative Implications. In this ", "score": 0.8088086 }, { "number": 11, "title": "Valve characteristics and surgical options for severe rheumatic mitral stenosis with more than mild regurgitation: A dual-center retrospective study - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0022522326000929", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Ann Thorac Surg\n\n### A systematic review of mitral valve repair with autologous pericardial leaflet augmentation for rheumatic mitral regurgitation\n\n### Ann Thorac Surg\n\n### Recent advances on the prevention and management of rheumatic heart disease\n\n### Glob Heart\n\n### Global epidemiology of va", "score": 0.7339103 }, { "number": 12, "title": "Outcomes of Severe Mitral Stenosis With the Revised Severity Criteria: Mitral Valve Replacement vs Percutaneous Mitral Valvuloplasty - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0828282X23016598", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Eur Heart J\n\n### 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines\n\n### J Am Coll Cardiol\n\n### Advances in rheumatic mitral stenosis: echocar", "score": 0.70799106 }, { "number": 13, "title": "Anesthetic Considerations for Patients with Advanced Valvular Heart Disease Undergoing Noncardiac Surgery - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1932227510000091", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Anesthetic Considerations for Patients with Advanced Valvular Heart Disease Undergoing Noncardiac Surgery - ScienceDirect\n# Anesthetic Considerations for Patients with Advanced Valvular Heart Disease Undergoing Noncardiac Surgery. Aortic stenosis (AS) has long been considered an important ris", "score": 0.6675167 }, { "number": 14, "title": "New in Clinical Documents | Implementing the New ACC/AHA Guideline on Valvular Heart Disease - American College of Cardiology", "detail": "www.acc.org", "url": "https://www.acc.org/latest-in-cardiology/articles/2021/01/01/12/42/new-in-clinical-documents-implementing-the-new-acc-aha-guideline-on-valvular-heart-disease", "authors": "www.acc.org", "host": "www.acc.org", "snippet": "Cardiology Magazine Image\n\nIn addition, the evidence for non-vitamin K oral anticoagulants (NOACs) has improved since the last guideline was published, and the new guideline includes a class 1 level A recommendation that states: \"For patients with AFib and native valve heart disease (except rheumati", "score": 0.77179235 }, { "number": 15, "title": "Primary mitral regurgitation: answers to clinical cardiologists’ most common questions", "detail": "www.escardio.org", "url": "https://www.escardio.org/communities/councils/cardiology-practice/education/cardiopractice/primary-mitral-regurgitation-answers-to-clinical-cardiologists-most-common-que", "authors": "www.escardio.org", "host": "www.escardio.org", "snippet": "12. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W; ESC/EACTS Scientific Document Group. 2021", "score": 0.4765072 }, { "number": 16, "title": "[PDF] Tendyne Holdings, Inc. CONFIDENTIAL CS0005-P MAC Feasibility ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/58/NCT03539458/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "Association for Cardio-Thoracic Surgery (ESC/EACTS) have published guidelines for the management of mitral disease [5][6]. In summary, the guidelines advise surgical treatment of primary MR when the lesion is severe and with symptoms, left ventricular dysfunction, or when cardiac surgery is being und", "score": 0.6437107 }, { "number": 17, "title": "2020 ACC/AHA guideline for the management of patients with ...", "detail": "www.jtcvs.org", "url": "https://www.jtcvs.org/article/S0022-5223(21)00592-4/fulltext", "authors": "www.jtcvs.org", "host": "www.jtcvs.org", "snippet": "Patients with rheumatic mitral stenosis or a mechanical prosthesis and atrial fibrillation should receive oral anticoagulation with a vitamin K", "score": 0.49099278 }, { "number": 18, "title": "Rationale and impact | Heart valve disease presenting in adults: investigation and management | Guidance | NICE", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/ng208/chapter/Rationale-and-impact", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "Evidence showed that an LVEF less than 60% was a risk factor for increased cardiac mortality after intervention for asymptomatic severe mitral regurgitation. An ESDI greater than 22 mm/m2 was associated with onset of symptoms, left ventricular dysfunction, or death without intervention. This is broa", "score": 0.48616135 }, { "number": 19, "title": "Sex-Related Factors in Valvular Heart Disease - JACC", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2021.08.081", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "The following paper reviews the sex differences in valvular heart disease presentation and management. AS = aortic stenosis; ACC/AHA guideline", "score": 0.35810664 }, { "number": 20, "title": "Mitral Annulus Calcium Score in Patients With Calcific Mitral ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/JAHA.123.030540", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Median diastolic mitral valve gradient was 9.4±3.4 mm Hg on echocardiography and 8.5±4 mm Hg invasively. Invasive median mitral valve area using", "score": 0.60049355 }, { "number": 21, "title": "Gradient Severe Mitral Stenosis - American Heart Association Journals", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/JAHA.118.010736", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Severe MS is defined by a mitral valve area (MVA) ≤1.5 cm2, but even with this degree of narrowing, mean mitral gradients (MGs) can vary considerably given", "score": 0.5809471 }, { "number": 22, "title": "Elevated Mitral Valve Pressure Gradient Is Predictive of Long‐Term ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/JAHA.118.011366", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The mitral valve area (MVA) used to characterize mitral valve stenosis. Mean MVPG is a well‐established echocardiographic parameter surrogate", "score": 0.5715041 }, { "number": 23, "title": "Current Evaluation and Management of Patients With Mitral Stenosis", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/01.cir.0000029210.14716.01", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The severity of MS can be graded on basis of the threshold of pulmonary edema at a certain cardiac output, heart rate, and MVA. mean PA pressures at rest and", "score": 0.56920683 }, { "number": 24, "title": "echocardiography and Doppler pressure half-time methods in ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/01.cir.73.1.100", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "the Doppler pressure half-time is superior to two-dimensional echocardiography in estimat- ing mitral valve area in patients who have undergone commissurotomy.", "score": 0.51369345 } ], "publishedAt": "2026-09-15T22:50:40.880962+00:00", "updatedAt": "2026-09-15T22:50:40.880962+00:00", "readingMinutes": 5, "slug": "mitral-stenosis" }