23
Table 15B. Intervention in Patients With MS
Recommendations
COR LOE
Percutaneous mitral balloon commissurotomy (PMBC)
is recommended for symptomatic patients with severe MS
(MVA ≤1.5 cm
2
, stage D) and favorable valve morpholog y in
the absence of le atrial thrombus or moderate-to-severe MR.
I A
MV surgery (repair, commissurotomy, or valve replacement)
is indicated in severely symptomatic patients (NYHA class
III-IV) with severe MS (MVA ≤1.5 cm
2
, stage D) who are
not high risk for surgery and who are not candidates for or
who have failed previous PMBC.
I B
Concomitant MV surgery is indicated for patients with
severe MS (MVA ≤1.5 cm
2
, stage C or D) undergoing
cardiac surgery for other indications.
I C
PMBC is reasonable for asymptomatic patients with very
severe MS (MVA ≤1.0 cm
2
, stage C) and favorable valve
morpholog y in the absence of le atrial thrombus or
moderate-to-severe MR.
IIa C
MV surgery is reasonable for severely symptomatic patients
(NYHA class III-IV) with severe MS (MVA ≤1.5 cm
2
,
stage D), provided there are other operative indications
(e.g., aortic valve disease, CAD, TR, aortic aneurysm).
IIa C
PMBC may be considered for asymptomatic patients with
severe MS (MVA ≤1.5 cm
2
, stage C) and valve morpholog y
favorable for PMBC in the absence of le atrial thrombus
or moderate-to-severe MR who have new onset of AF.
IIb C
PMBC may be considered for symptomatic patients with
MVA >1.5 cm
2
if there is evidence of hemodynamically
significant MS based on pulmonary capillary wedge pressure
(PCWP) >25 mm Hg or mean MV gradient >15 mm Hg
during exercise.
IIb C
PMBC may be considered for severely symptomatic patients
(NYHA class III-IV) with severe MS (MVA ≤1.5 cm
2
,
stage D) who have suboptimal valve anatomy and who are
not candidates for surgery or are at high risk for surgery.
IIb C
Concomitant MV surgery may be considered for patients
with moderate MS (MVA 1.6–2.0 cm
2
) undergoing cardiac
surgery for other indications.
IIb C
MV surgery and excision of the le atrial appendage may
be considered for patients with severe MS (MVA ≤1.5 cm
2
,
stages C and D) who have had recurrent embolic events
while receiving adequate anticoagulation.
IIb C
