Management of Rheumatic Mitral Stenosis - Flowchart

Management of Rheumatic Mitral Stenosis - Flowchart

Management of Rheumatic Mitral Stenosis - Flowchart

«Flowchart»

Rheumatic MS

Rheumatic MS

Rheumatic MS

Rheumatic MS

Asymptomatic (stage C)

Asymptomatic (stage C)

Asymptomatic (stage C)

Symptomatic (stage D)

Symptomatic (stage D)

Symptomatic (stage D)

PBMC (IIa)

PBMC (IIa)

PBMC (IIa)

PBMC (IIa)

Periodic monitoring

Periodic monitoring

Periodic monitoring

Favorable valve morphology
No LA clot
No or mild MR

Favorable valve morphology
No LA clot
No or mild MR

Favorable valve morphology
No LA clot
No or mild MR

Yes

Yes

Yes

No

No

No

End

End

End

PBMC (I)

PBMC (I)

PBMC (I)

PBMC (I)

Favorable valve morphology
No LA clot
No or mild MR

Favorable valve morphology
No LA clot
No or mild MR

Favorable valve morphology
No LA clot
No or mild MR

Yes

Yes

Yes

No

No

No

MVR (I)

MVR (I)

MVR (I)

MVR (I)

PBMC (IIb)

PBMC (IIb)

PBMC (IIb)

PBMC (IIb)

NYHA class III-IV symptoms with high surgical risk

NYHA class III-IV symptoms with high surgical risk

NYHA class III-IV symptoms with high surgical risk

Yes

Yes

Yes

No

No

No

Symptomatic (stage D)

Symptomatic (stage D)

Symptomatic

Asymptomatic (stage C)

Asymptomatic (stage C)

Asymptomatic

Symptomatic with no other cause

Symptomatic with no other cause

Symptomatic with no other cause

Periodic monitoring

Periodic monitoring

Periodic monitoring

Favorable valve morphology
No LA clot
No or mild MR

Favorable valve morphology
No LA clot
No or mild MR

Favorable valve morphology
No LA clot
No or mild MR

Yes

Yes

Yes

No

No

No

New-onset AF

New-onset AF

New-onset AF

Yes

Yes

Yes

No

No

No

Very severe MS
MVA 1 cm²
T½ 220 ms

Very severe MS
MVA 1 cm²
T½ 220 ms

Very severe MS

²

Very severe MS

Severe MS
MVA 1.5 cm²
T½ 150 ms

Severe MS
MVA 1.5 cm²
T½ 150 ms

Severe MS

²

Severe MS

Progressive MS
MVA >1.5 cm²
T½ <150 ms

Progressive MS
MVA >1.5 cm²
T½ <150 ms

Progressive MS
²
Progressive MS

Periodic monitoring

Periodic monitoring

Periodic monitoring

PBMC (IIb)

PBMC (IIb)

PBMC (IIb)

PBMC (IIb)

PCWP >25 mmHg with exercise

PCWP >25 mmHg with exercise

PCWP >25 mmHg with exercise

Yes

Yes

Yes

No

No

No