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) 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) 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) I

PBMC (IIb)

PBMC (IIb)

PBMC (IIb)

PBMC (IIb) 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 
220 ms

Very severe MS
MVA 1 cm2 
220 ms

Very severe MS
2
Very severe MS

Severe MS
MVA 1.5 cm2 
150 ms

Severe MS
MVA 1.5 cm2 
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) IIb

PCWP >25 mmHg with exercise

PCWP >25 mmHg with exercise

PCWP >25 mmHg with exercise

Yes

Yes

Yes

No

No

No

MR, mitral regurgitation; MS, mitral stenosis; MVA, mitral valve area; MVR, mitral valve surgery (repair or replacement); NYHA, New York Heart Association; PCWP, pulmonary capillary wedge pressure; PMBC, percutaneous mitral balloon commissurotomy; T½, pressure half-time.

MR, mitral regurgitation; MS, mitral stenosis; MVA, mitral valve area; MVR, mitral valve surgery (repair or replacement); NYHA, New York Heart Association; PCWP, pulmonary capillary wedge pressure; PMBC, percutaneous mitral balloon commissurotomy; T½, pressure half-time.

MR, mitral regurgitation; MS, mitral stenosis; MVA, mitral valve area; MVR, mitral valve surgery (repair or replacement); NYHA, New York Heart Association; PCWP, pulmonary capillary wedge pressure; PMBC, percutaneous mitral balloon commissurotomy; T½, pressure half-time.

Class I

Class I

Class I

Class IIa

Class IIa

Class IIa

Class IIb

Class IIb

Class IIb