19
Figure 4. Indications for Intervention in Patients With
Rheumatic MS
Rheumatic MS
Very severe MS
MVA ≤1 cm
2
T
1
/2 ≥220 ms
Severe MS
MVA ≤1.5 cm
2
T
1
/2 ≥150 ms
Progressive MS
MVA >1.5 cm
2
T
1
/2 <150 ms
Asymptomatic
(stage C)
Symptomatic
(stage D)
Asymptomatic
(stage C)
Symptomatic
with no other
cause
• Favorable valve
morphology
• No LA clot
• No or mild MR
• Favorable valve
morphology
• No LA clot
• No or mild MR
New onset
AF
NO YES
PCWP >25 mm Hg
with exercise
Periodic
Monitoring
PMBC
(IIa)
NO YES
PMBC (IIb)
PMBC
(I)
NYHA
class III-IV
symptoms
with high
surgical risk
MVR
(I)
NO YES
NO
YES
• Favorable valve
morphology
• No LA clot
• No or mild MR
NO YES
Periodic
Monitoring
YES NO
PMBC
(IIb)
Mitral Stenosis
