Longitudinal Hemodynamic and Clinical Study of Mitral Stenosis

Abstract

Forty-two patients with pure mitral stenosis underwent a prospective, longitudinal study with two or more cardiac catheterizations 1 to 10 years apart and without intervening surgical treatment. The majority of patients had not previously had mitral valve surgery; in 16, the period of observation followed valvotomy. Twenty-seven patients showed evidence of progressive obstruction of the mitral valve; 15 showed no change in the calculated mitral valve area. In the group of patients with progressive disease (stenosis or restenosis) there was a consistent clinical and hemodynamic deterioration: 25 of the 27 showed increasing disability. In the nonprogressive group, seven of the 15 showed increasing symptomatology, most often related to the development of atrial fibrillation and a fall in cardiac output. Possible causes for the different course of mitral stenosis in the two groups are reviewed. The probability that trauma due to altered flow patterns through a stenotic valve produces progressive stenosis is suggested.

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…In some geographic areas, MS progresses more rapidly, presumably due to either a more severe rheumatic insult or repeated episodes of rheumatic carditis due to new streptococcal infections, resulting in severe symptomatic MS in the late teens and early 20s (380). Serial hemodynamic and Doppler-echocardiographic studies have reported annual loss of MV area ranging from 0.09 to 0.32 cm 2 (385,386). Although MS is best described as a disease continuum, and there is no single value that defines severity, for these guidelines, MS severity is based on a variety of hemodynamic and natural history data (Table 4) (27) using mean gradient, pulmonary artery systolic pressure, and valve area as follows: mild (area greater than 1.5 cm 2 , mean gradient less than 5 mm Hg, or pulmonary artery systolic pressure less than 30 mm Hg), moderate (area 1.0 to 1.5 cm 2 , mean gradient 5 to 10 mm Hg, or pulmonary artery systolic pressure 30 to 50 mm Hg), and severe (area less than 1.0 cm 2 , mean gradient greater than 10 mm Hg, or pulmonary artery systolic pressure greater than 50 mm Hg).…”

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…In some geographic areas, MS progresses more rapidly, presumably due to either a more severe rheumatic insult or repeated episodes of rheumatic carditis due to new streptococcal infections, resulting in severe symptomatic MS in the late teens and early 20s (380). Serial hemodynamic and Doppler-echocardiographic studies have reported annual loss of MV area ranging from 0.09 to 0.32 cm 2 (385,386).…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…380 Serial hemodynamic and Dopplerechocardiographic studies have reported annual loss of MV area ranging from 0.09 to 0.32 cm 2 . 385,386 Although MS is best described as a disease continuum, and there is no single value that defines severity, for these guidelines, MS severity is based on a variety of hemodynamic and natural history data (Table 4) 27 using mean gradient, pulmonary artery systolic pressure, and valve area as follows: mild (area greater than 1.5 cm 2 , mean gradient less than 5 mm Hg, or pulmonary artery systolic pressure less than 30 mm Hg), moderate (area 1.0 to 1.5 cm 2 , mean gradient 5 to 10 mm Hg, or pulmonary artery systolic pressure 30 to 50 mm Hg), and severe (area less than 1.0 cm 2 , mean gradient greater than 10 mm Hg, or pulmonary artery systolic pressure greater than 50 mm Hg).…”