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Published on: May 19, 2020
Rheumatic Mitral Stenosis
1Cardiac Catheterization Laboratory, University of Chicago Hospital, 5841 S. Maryland Ave., MC 5076, Chicago, IL 60637, USA.
Insights
Percutaneous transvenous mitral commissurotomy (PTMC) is recommended for symptomatic mitral stenosis patients with suitable valve morphology, offering outcomes comparable to surgery. Valve replacement is for severe deformities, while PTMC can be a palliative option for high-risk older patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Mitral stenosis is a significant valvular heart disease.
- Current treatment guidelines emphasize echocardiography for evaluation.
- Percutaneous transvenous mitral commissurotomy (PTMC) is a key therapeutic option.
Purpose of the Study:
- To outline the management strategy for symptomatic and asymptomatic mitral stenosis.
- To define patient selection criteria for percutaneous transvenous mitral commissurotomy (PTMC).
- To compare PTMC with surgical commissurotomy and mitral valve replacement.
Main Methods:
- Transthoracic and transesophageal echocardiography for patient evaluation.
- Percutaneous transvenous mitral commissurotomy (PTMC) for suitable candidates.
- Review of randomized trials comparing catheter and surgical commissurotomy.
- Assessment of mitral valve replacement for severe deformities.
Main Results:
- PTMC shows no long-term outcome difference compared to surgical commissurotomy in suitable patients.
- Surgical commissurotomy has no role when balloon commissurotomy is feasible.
- Mitral valve replacement is indicated for severe valve deformities.
- PTMC can be a palliative option for high-risk older patients.
Conclusions:
- PTMC is the preferred treatment for suitable mitral stenosis patients.
- Echocardiography is crucial for guiding treatment decisions.
- Asymptomatic patients with pulmonary hypertension may benefit from PTMC.
Abstract:
Patients with symptomatic mitral stenosis should undergo evaluation with transthoracic and transesophageal echocardiography (Table 1). Those patients with suitable valve morphology should be treated with percutaneous transvenous mitral commissurotomy (PTMC). Randomized trials of catheter commissurotomy have shown no differences in long-term outcome compared with surgical commissurotomy; there is therefore no role for surgical commissurotomy in patients who are suitable candidates for balloon commissurotomy. Mitral valve replacement should be recommended for those patients with valve deformity too severe to undergo catheter therapy. Some older patients who are less-than-ideal candidates for catheter therapy nonetheless may benefit from it as a palliative alternative to otherwise high-risk valve surgery. Asymptomatic patients should be screened for the presence of pulmonary artery hypertension. Those who have pulmonary artery systolic pressure at rest of greater than 50 mm Hg or who develop pulmonary artery systolic pressure of greater than 60 mm Hg with exercise should be considered for PTMC.
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