Mitral Stenosis - Assessment
Mitral Stenosis Severity Scales
Pressure half-time
- Normal : 30 to 60 milliseconds
- Abnormal : 90 to 400 ms
- Gray area : 60 to 90 ms
- Mild MS : 90 to 150 ms
- Moderate MS : 150 to 219 ms
- Severe MS : > 220 ms
Mitral valve area
- Normal : 4 to 6 cm2
- Mild MS : 1.5 to 2.5 cm2
- Moderate MS : 1.0 to 1.5 cm2
- Severe MS :<1.0 cm2
End-diastolic pressure gradient
- Normal : 0 to 2 mm Hg
- Mild MS : 2 to 6mmHg
- Moderate MS : 6 to 10 mm Hg
- Severe MS : >10 mm Hg
Mean pressure gradient
- Mild MS : < 5 mmHg
- Moderate MS : 6 to 12 mm Hg
- Severe MS : > 12 mm Hg
Echo Score Index for Mitral Stenosis to assess for balloon valvotomy
Mobility
- Grade 1 : Highly mobile valve with leaflet tips only restricted
- Grade 2 : Leaflet mid and base portions have normal mobility
- Grade 3 : Valve continues to move forward in diastole mainly from the base
- Grade 4 : No or minimal forward movement of the leaflets in diastole
Leaflet thickening
- Grade 1 : Leaf1ets near normal in thickness (4 to 5 mm)
- Grade 2 : Mid-leaflets normal, marked thickening of margins (5 to 8 mm)
- Grade 3 : Thickening extending through the entire leaflet (5 to 8 mm)
- Grade 4 : Thickening of all leaflet tissue (> 8 mm)
Subvalvular thickening
- Grade 1: Minimal thickening just below the mitral leaflets
- Grade 2: Thickening of chordal structures extending up to one third of the chordal length
- Grade 3: Thickening extending to the distal third of the chords
- Grade 4: Extensive thickening and shortening of all chordal structures extending down to the papillary muscles
Calcification
- Grade 1: A single area of increased echocardiographic brightness
- Grade 2: Scattered areas of brightness confined to the leaflet margins
- Grade 3: Brightness extending into the mid portion of the leaflets
- Grade 4: Extensive brightness throughout much of the leaflet tissue
To determine the echocardiographic score add the grades from the 4 categories. The minimum score is 4 and maximum score is 16. Patients with score < 8 are more favorable candidates for balloon valvotomy.
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