Low gradient severe mitral stenosis

Low gradient severe mitral stenosis Low gradient severe mitral stenosis has been defined as mean transmitral gradient <10 mm Hg in patients with mitral valve area ≤1.5 cm2 [1]. A low flow subgroup has been defined with left ventricular stroke volume index ≤35 mL/m2. In a study of 101 patients with severe rheumatic mitral stenosis who underwent balloon valvuloplasty, low gradient was present in 55 patients and low flow low gradient in 11 patients [1]. Low flow low gradient mitral stenosis patients were older, had higher rates of atrial fibrillation, arterial afterload, subvalvular thickening and decreased left ventricular compliance compared to high gradient mitral stenosis [1]. 40% of those with low gradient mitral stenosis did not have symptomatic benefit compared to 18% with high gradient, after valvuloplasty. European Association of Echocardiography/American Society of Echocardiography recommendation in 2009 had defined severe mitral stenosis as valve area <1 cm2 [2].  2014 AHA/ACC Guideline defines severe mitral stenosis as valve area ≤1.5 cm2 [3]. An earlier study of 180 patients who underwent percutaneous balloon mitral valvuloplasty found 36 patients with transmitral gradient ≤10 mm Hg [4]. 24 of these 36 patients (67%) had reduced left ventricular ejection fraction. Those with reduced left ventricular ejection fraction were noted to have left ventricular wall motion abnormalities on ventriculography. Balloon valvuloplasty did not signific...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Echocardiography Source Type: blogs