Mitral stenosis

 

Disease:

Causes

·      Degeneration

·      Rheumatic (indigenous, overseas-born)

·      Connective tissue disease

·      Congenital

Complications

Forward:

·      Fixed cardiac output

·      Embolic stroke

Backward:

·      Left atrial enlargement

·      Atrial arrhythmias

·      Pulmonary oedema

·      Pulmonary hypertension

·      Right heart failure

 

Echo diagnosis:

Qualitative

·      Thickened, calcified, immobile leaflets

·      Thickened subvalvular apparatus

Quantitative

·      Valve area

o  Planimetry

o  P1/2t

o  Continuity equation

·      Gradients (from Bernoulli equation)

o  Mean gradient

o  End-diastolic gradient

Complications

·      Dilated LA

·      Pulmonary hypertension

·      RV dysfunction

 

Echo severity:

 

Mild

Moderate

Severe

Mean gradient

<6

6-12

>12

Valve area*

1.5-2.5

1.0-1.5

<1.0

P1/2t

<140ms

140-220ms

>220ms

mPAP

<30

30-50

>50

Notes:

·        Normal area is 4-6cm2

·        Progression 0.2cm2 / year

 

Anaesthesia:

Goals

Maintain cardiac output

·      ↓Rate and sinus rhythm

·      ↑Preload

·      ↑Afterload

 

 

 

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