22
Table 15A. Diagnosis and Medical Therapy in Patients
With MS
Recommendations COR LOE
TTE is indicated in patients with signs or symptoms of MS
to establish the diagnosis, quantify hemodynamic severity
(ΔPmean, MVA, and pulmonary artery [PA] pressure),
assess concomitant valvular lesions, and demonstrate
valve morpholog y (to determine suitability for mitral
commissurotomy).
I B
TEE should be performed in patients considered for PMBC
to assess the presence or absence of le atrial thrombus and
to further evaluate the severity of MR.
I B
Exercise testing with Doppler or invasive hemodynamic
assessment is recommended to evaluate the response of
the mean mitral gradient and PA pressure in patients with
MS when there is a discrepancy between resting Doppler
echocardiographic findings and clinical symptoms or signs.
I C
Anticoagulation (VKA or heparin) is indicated in patients
with
• MS and AF (paroxysmal, persistent, or permanent), or
• MS and a prior embolic event, or
• MS and a left atrial thrombus.
I B
Heart rate control can be beneficial in patients with MS and
AF and fast ventricular response.
IIa C
Heart rate control may be considered for patients with MS in
normal sinus rhythm and symptoms associated with exercise.
IIb B
Mitral Stenosis
