1. Timing of Intervention in Mitral Stenosis
Ted Feldman, M.D., FSCAI FACC FESC
Evanston Hospital
CRT
Cardiovacular Research Technologies
Washington, D.C.
February 23 – 26, 2013

2. Ted E. Feldman, MD Consulting: Abbott Laboratories
Boston Scientific Corporation
Edwards Lifesciences, LLC

5. Indications for Percutaneous Mitral Balloon Valvotomy
CLASS
Indication I A
Symptomatic, MVA ≤1.5cm2, MR≤2, no LA clot C
Asymptomatic, PASP>50mm Rest/60mm exercise
IIa
Calcified valve, NYHA III–IV, and are either not candidates or high risk for surgery
IIb
Asymptomatic with new onset of atrial fibrillation
Symptomatic, MVA>1.5 , PASP>60 mmHg, PCW≥25 mm, mn MV gradient >15mm Hg exercise
Alternative to surgery with mod-severe MS, calcified valve, NYHA III–IV
III
Mild MS, moderate to severe MR or left atrial clot
JACC 52, 2008:e1–142

6. Indications for Percutaneous Mitral Balloon Valvotomy
CLASS
Indication I A
Symptomatic, MVA ≤1.5cm2, MR≤2, no LA clot C
Asymptomatic, PASP>50mm Rest/60mm exercise
IIa
Calcified valve, NYHA III–IV, and are either not candidates or high risk for surgery
IIb
Asymptomatic with new onset of atrial fibrillation
Symptomatic, MVA>1.5 , PASP>60 mmHg, PCW≥25 mm, mn MV gradient >15mm Hg exercise
Alternative to surgery with mod-severe MS, calcified valve, NYHA III–IV
III
Mild MS, moderate to severe MR or left atrial clot
JACC 52, 2008:e1–142

7. ECHO Score Mobility Subvalvular Thickening Calcium 1 tips restricted
minimal thickening
nl (4-5mm)
single area 2
mid & base nl
1/3 chordal length
leaflet margins 5-8mm
scattered 3
valve moves forward
thick to distal chords
entire leaflet 5-8mm
mid leaflets 4
barely mobile
extensive to paps
>8-10mm thick
extensive
Br Heart J 60:299,1988

8. Spectrum of Valve DeformityLA
Mild
Moderate
Severe LV LA LV LA

9. Left Atrial Smoke

10. Left Atrial Thrombus Resolution After Warfarin Therapy
PRE PRE Post 4 months warfarin
80% of thrombi resolve after 2 months of anticoagulation
AHJ 140:150,2000

11. Organized Left Atrial Thrombus
65F, CABG 6 months prior, Stroke 2 months prior
Coumadin 8 for weeks, Successful PTMC

12. Leaflet Lesion Recent TIA

13. Mitral Stenosis & Mitral Annular Calcification

14. Calcific Mitral Stenosis Dialysis

15. Bioprosthetic Mitral Stenosis
88YO female with atrial fibrillation & bioprosthetic aortic and mitral valve replacement, TV repair in 2009

16. Bioprosthetic Stenosis
24mm
PTMC