21
Valve Hemodynamics
a
Hemodynamic
Consequences Symptoms
• Normal transmitral flow velocity • None None
• Increased transmitral flow velocities
• MVA >1.5 cm
2
• Diastolic pressure half-time <150 ms
• Mild-to-moderate
left atrium (LA)
enlargement
• Normal pulmonary
pressure at rest
None
• MVA ≤1.5 cm
2
(MVA ≤1.0 cm
2
with severe MS)
• Diastolic pressure half-time ≥150 ms
(Diastolic pressure half-time ≥220 ms
with severe MS)
• Severe LA
enlargement
• Elevated PASP
>30 mm Hg
None
• MVA ≤1.5 cm
2
(MVA ≤1.0 cm
2
with very severe MS)
• Diastolic pressure half-time ≥150 ms
(Diastolic pressure half-time ≥220 ms
with very severe MS)
• Severe LA
enlargement
• Elevated PASP
>30 mm Hg
• Decreased
exercise
tolerance
• Exertional
dyspnea
a
e transmitral ΔPmean should be obtained to further determine the hemodynamic effect of the MS
and is usually >5–10 mm Hg in severe MS. However, due to the variability of the ΔPmean with heart
rate and forward flow, it has not been included in the criteria for severity.
