Cardiology Essentials in Clinical Practice by Gabriel A. Adelmann

Author:Gabriel A. Adelmann
Language: eng
Format: epub
Publisher: Springer London, London

5.2.3.2 Interventional Therapy

Interventional therapy for pure MS is indicated in case of severe stenosis (MV area <1.5 cm2), if the patient displays symptoms or signs of complications or is about to face hemodynamic challenges (major noncardiac surgery, pregnancy). Absolute indications include any case of MS that is symptomatic at rest or on mild exertion, but comorbidity (severe PAH or additional VHD) may cause symptoms at lesser degrees of MS severity. The converse is not true, as even severe MS may be clinically silent, especially in sedentary patients. Therefore, true asymptomatic status is defined as the absence of symptoms during exercise test (by the Bruce or modified Bruce protocol, or using Dobutamine); in patients in whom other clinical parameters (old age, comorbidity) dictate a sedentary life style anyway, this point may be moot. PMV, if feasible, is the default option, unless there is another compelling indication for open-heart surgery (e.g., severe CAD); in these patients, surgical valvuloplasty or MV replacement is indicated. Relative indications for intervention (valve replacement not indicated, but valvuloplasty may be warranted) generally refer to patients with ongoing or past complications, or at risk of hemodynamic decompensation. As always, however, the decision to intervene is individually tailored. The common clinical scenarios are presented in Table 5.9.Table 5.9MS: indications for percutaneous mitral valvuloplasty (PMV)a

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