Mitral stenosis surgery indications


 * Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Overview
Although mitral valvuloplasty is an effective less invasive treatment modality compared to surgery, mitral valve surgery is indicated if the mitral valve is severely calcified, if there is moderate to severe mitral regurgitation coexists with MS, if mitral valvuloplasty is not available or the patient has unfavorable valve morphology, and if there is left atrial thrombus that persists despite anticoagulation.

Indications
There is improvement in the mortality rates for mitral stenosis by intervention by percutaneous mitral balloon valvotomy or surgery. The 2006 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of valvular heart disease recommended intervention in symptomatic patients with moderate to severe mitral stenosis.

In asymptomatic patients, intervention is recommended in moderate to severe MS and pulmonary hypertension (pulmonary artery systolic pressure >50 mmHg at rest or >60 mmHg with exercise).

The ACC/AHA guidelines indicates surgery when one of the following is presents :


 * The mitral valve is severely calcified.
 * Moderate to severe mitral regurgitation coexists with MS.
 * PMBV is not available or the patient has unfavorable valve morphology.
 * There is left atrial thrombus that persists despite anticoagulation.

Valve replacement improves long-term survival along with symptomatic improvement if the patient could not be treated by either PMBV or valve repair.

==ACC/AHA Guidelines- Indications for Surgery for Mitral Stenosis (DO NOT EDIT) == {{cquote|

Class I
1. MV surgery (repair if possible) is indicated in patients with symptomatic (NYHA functional class III–IV) moderate or severe MS* when 1) percutaneous mitral balloon valvotomy is unavailable, 2) percutaneous mitral balloon valvotomy is contraindicated because of left atrial thrombus despite anticoagulation or because concomitant moderate to severe MR is present, or 3) the valve morphology is not favorable for percutaneous mitral balloon valvotomy in a patient with acceptable operative risk. (Level of Evidence: B)

2. Symptomatic patients with moderate to severe MS* who also have moderate to severe MR should receive MV replacement, unless valve repair is possible at the time of surgery. (Level of Evidence: C)

Class IIa
1. MV replacement is reasonable for patients with severe MS* and severe pulmonary hypertension (pulmonary artery systolic pressure greater than 60 mm Hg) with NYHA functional class I–II symptoms who are not considered candidates for percutaneous mitral balloon valvotomy or surgical MV repair. (Level of Evidence: C)

Class IIb
1. MV repair may be considered for asymptomatic patients with moderate or severe MS* who have had recurrent embolic events while receiving adequate anticoagulation and who have valve morphology favorable for repair. (Level of Evidence: C)

Class III
1. MV repair for MS is not indicated for patients with mild MS. (Level of Evidence: C)

2. Closed commissurotomy should not be performed in patients undergoing MV repair; open commissurotomy is the preferred approach. (Level of Evidence: C)}}