Heart valve disease (mitral valve disease): mitral stenosis
- DOI:
- 10.1093/med/9780198726012.003.0035
The most common cause of mitral stenosis (MS) is rheumatic fever followed by degenerative MS. Echocardiography is the key method to diagnose and evaluate MS. Echocardiographic findings are closely related to aetiology. In rheumatic disease echocardiography shows thickening of leaflet tips with restricted opening caused by commissural fusion resulting in ‘doming’ of the mitral valve in diastole. Quantitation of MS severity includes measuring mitral valve area (MVA) by planimetry (anatomical area, by two-/three-dimensional echo), or by the pressure half-time (PHT) method (functional area, by Doppler), and the mean pressure gradient. Planimetry is considered the reference method to determine MVA as it is relatively load independent. The PHT method is widely used due to its simplicity, but different factors influence the relationship between PHT and MVA. Other indices of MS severity are rarely used in clinical practice. Echocardiography also helps in the assessment of consequences of MS, and of associated valvular lesions. Exercise Doppler is recommended when there is discrepancy between the resting echocardiography findings and the clinical picture. Echocardiography is crucial in determining the timing and type of intervention in patients with MS. When considering percutaneous mitral commissurotomy (PMC) valve morphology should be comprehensively evaluated for mobility, thickness, calcifications, and subvalvular apparatus. The echo findings may determine the suitability for PMC, guide the procedure, and assess its results.
Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.
Please subscribe or login to access full text content.
If you have purchased a print title that contains an access token, please see the token for information about how to register your code.
For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.