Advances in Rheumatic Mitral Stenosis: Echocardiographic, pathophysiologic and hemodynamic considerations.

Abstract

Echocardiography is the primary imaging modality employed in patients with mitral stenosis. Doppler-derived measurements of mitral pressure half-time are commonly used to calculate mitral valve area however a number of hemodynamic confounders associated with advanced age limit its utility. Planimetry remains the gold standard for determining mitral valve area and may be performed using 2- or 3-dimensional imaging. While the Wilkins score has been used for > 30 years to predict balloon mitral valvuloplasty outcomes, newer scoring systems have been proposed to improve predictive accuracy. Some patients undergoing technically successful balloon mitral valvuloplasty may not have satisfactory clinical outcomes. These individuals may be identified by the presence of reduced net atrio-ventricular compliance which can be measured echocardiographically. Exercise testing may be useful in patients with mitral stenosis whose symptomatic status is incongruous their mitral valve area. Last, reduced left atrial systolic strain, an indicator of poor left atrial compliance, has been shown to reliably predict adverse outcomes in patients with mitral stenosis. This article discusses the hemodynamics and pathophysiology of mitral stenosis and reviews current and emerging roles of echocardiography in its evaluation.