ASE VS guidelines
shortening and fusion, and leaflet thickening, and later in the disease leaflet
motion.
Degenerative MS: in which the main lesion is annular calcification. It is
frequently observed in the elderly and associated with hypertension,
atherosclerotic disease, and sometimes AS. However, calcification of the
mitral annulus has few or no haemodynamic consequences when isolated
and causes more often MR than MS.
Congenital MS: is mainly the consequence of abnormalities of the
subvalvular apparatus. Other causes are rarely encountered: inflammatory
diseases (e.g. systemic lupus), infiltrative diseases, carcinoid
heart disease, and drug-induced valve diseases. Leaflet thickening and
restriction are common here, while commissures are rarely fused.
Mean gradient is the relevant haemodynamic finding. Maximal gradient is of
little interest as it derives from peak mitral velocity, which is influenced by left
atrial compliance and LV diastolic function.
-In AF: mean gdt avg of 5 cycles (least R-R variation)
-not the best marker of the severity of MS since it is
dependent on the (MVA) as well as a number of other
factors that influence transmitral flow rate, the most
important being heart rate,CO, and associated MR
anatomical valve area as assessed on explanted valves    (level 1)
-In AF: mean gdt avg of 5 cycles (least R-R variation)
-not the best marker of the severity of MS since it is
dependent on the (MVA) as well as a number of other
factors that influence transmitral flow rate, the most
important being heart rate,CO, and associated MR
Level of recommendations: (1) appropriate in all patients (yellow); (2) reasonable when additional
information is needed in selected patients (green); and (3) not recommended (blue).
-Time interval in msec between the maximum mitral gdt in
early diastole and the time point where the gdt is half the
diastolic transmitral blood flow is inversely proportional to
valve area (cm2), and MVA is derived using:
-Short T1/2 can be observed despite severe MS in pts
with low atrial compliance, associated severe AR
4-Continuity Equation: (level 2)
-Same concept as AVA.
5-PISA: (level 2)
-Same concept as AVA.
6-Mitral Valve resistance: (level 3)
-Defined as the ratio of mean mitral gradient to transmitral diastolic flow rate, which is calculated
by dividing SV by diastolic filling period. Mitral valve resistance is an alternative measurement of
the severity of MS, which has been argued to be less dependent on flow conditions. This is,
however, not the case.
Assessment of mitral valve anatomy according to the Wilkins score (1988):
Assessment of mitral valve anatomy according to the Cormier score:
-Any degree of severe MS is associated with a certain level of PHTN except when there is
associated TS.
-Mitral commissurotomy is Contraindicated when:
.More than mild MR
.Asymetric pattern of calcification of leaflets (balloon will follow the path of least resistance only
creating MR)

-The presence of
MR does not alter the validity of the quantitation of MS, except for the
continuity-equation valve area.

-The severity of
AS may be underestimated because decreased SV due to MS reduces aortic
gradient, thereby highlighting the need for the estimation of AVA. In cases of severe AR, the
T1/2 method for assessment of MS is not valid.

-
Consequences of MS include the quantitation of left atrial size and the estimation of systolic
pulmonary artery pressure.

-
Exercise testing is recommended in patients with MVA, 1.5 cm2 who claim to be asymptomatic
or with doubtful symptoms.
MVA = pi/4 x a x b (a=longest diameter, b=shortest diameter by short axis - assuming an elliptical shape).
Normal MVA 4-5 cm2
good outcome for balloon
commissurotomy
MS Trt: BB and ACE i

MS = increased LA pressure = pulm
HTN

MS+TS=protective against pulm HTN