Mitral Stenosis

2D Features of MS

Leaflet doming & thickening

Spectral Doppler Features of Severe MS

Gradual slope

Using Peak Velocity for MS

Only use to assess PHT and diastolic function

Do not use to calculate peak pressure gradient

Mean Pressure Gradient for Severe MS

> 10 mmHg

Limitations of using Peak Velocities and Pressure Gradients

Poor Doppler signal

Poor beam alignment/sample placement

Pressure Half Time for MS

Independent of MR

Inversely proportional to valve area

The greater the PHT...

The more severe the MS

Limitations of PHT

Poor Doppler signal, beam alignment, sample placement

Diastolic dysfunction can overestimate

Needs 3-5 cycles for good average

Planimetry

2D measurement that calculates area by tracing open leaflets in PSAX

Must be at leaflet tips

MVA for Mild MS

2.5-1.5 cm^2

MVA for Severe MS

< 1 cm^2

Planimetry Limitations

Poor window

Not at leaflet tips

Thickened cordae/calcifications

Over-gaining

Valves that use the Continuity Equation

MV

TV

PV

Continuity Equation for MVA

Calculates valve area using LVOT CSA & VTI, and MV VTI

Limitations of the Continuity Equation for MVA

Not valid if significant AI or MR are present

PISA for MS

Measure MV peak velocity

Measure flow convergence radius on atrial side of MV

Additional Measurement(s) when MS is Present

Pulmonary A pressure

Pulmonary A Pressure with Mild MS

< 30 mmHg

Pulmonary A Pressure with Severe MS

> 50 mmHg

Valvuloplasty Scoring Model

Semi-quantitative way to assess valve leaflets

Used when MS and MR are present

Valvuloplasty Scoring Model Criteria

Leaf thickening

Leaflet mobility

Leaflet calcification

Subvalvular thickening

Valvuloplasty Scoring

1 = normal

2 = mildly abnl

3 = moderately abnl

4 = severely abnl

< 8 is favorable for valvuloplasty/surgical treatment

> 8 indicates need for prosthetic valve

Pressure Changes with MS

Increased LA pressure

Decreased LV pressure