What is the mitral valve area measurement indicating high risk in patients with rheumatic mitral stenosis?
s1.5 cm
Patients with this measurement are at high risk of embolism or haemodynamic decompensation.
What are the high risks associated with a patient having rheumatic mitral stenosis?
- Embolism
- Haemodynamic decompensation
These risks necessitate careful management and monitoring.
What type of testing is important for patients with rheumatic mitral stenosis?
Exercise testing
This helps assess the patient’s functional capacity and symptoms.
What are the favourable characteristics for percutaneous mitral balloon commissurotomy (PMC)?
- Favourable anatomical characteristics
- Favourable clinical characteristics
These characteristics can influence the decision to proceed with PMC.
What constitutes a contraindication for surgery in patients with rheumatic mitral stenosis?
High risk for surgery
Identifying contraindications is crucial for patient safety.
True or false: Patients with rheumatic mitral stenosis and a mitral valve area of s1.5 cm should undergo surgery without any considerations.
FALSE
Surgery must be carefully evaluated against risks and contraindications.
What is recommended for symptomatic patients in the absence of unfavourable characteristics for PMC?
PMC is recommended
PMC stands for percutaneous mitral balloon commissurotomy.
In which patients is PMC recommended?
- Symptomatic patients with contraindication or high risk for surgery
- Symptomatic patients without unfavourable characteristics for PMC
- Asymptomatic patients with high thrombo-embolic risk
- Asymptomatic patients with high risk of haemodynamic decompensation
High thrombo-embolic risk includes history of systemic embolism, dense spontaneous contrast in the LA, or new-onset/paroxysmal AF.
What is recommended for symptomatic patients who are not suitable for PMC?
MV surgery is recommended
MV stands for mitral valve.
When should PMC be considered as initial treatment?
In symptomatic patients with suboptimal anatomy but no unfavourable clinical characteristics for PMC
Suboptimal anatomy refers to anatomical features that may complicate the procedure.
What conditions indicate a high thrombo-embolic risk for asymptomatic patients?
- History of systemic embolism
- Dense spontaneous contrast in the LA
- New-onset or paroxysmal AF
LA stands for left atrium.
What defines a high risk of haemodynamic decompensation?
- SPAP >50 mmHg at rest
- Need for major NCS
- Pregnant or desire for pregnancy
SPAP stands for systolic pulmonary artery pressure.
In which patients may TMVI be considered?
Symptomatic patients with extensive MAC and severe MV dysfunction
TMVI stands for transcatheter mitral valve intervention and MAC stands for mitral annular calcification.
What is required for performing TMVI?
Expertise in complex MV surgery and transcatheter interventions at experienced Heart Valve Centres
This ensures safety and efficacy in high-risk procedures.
