Treatment of Rheumatic Mitral Stenosis with Mitral Valve Area ≤1.5 cm² (Clinically Severe)
This protocol addresses patients with rheumatic mitral stenosis and a mitral valve area ≤1.5 cm². At this threshold, when combined with symptoms, elevated thromboembolic risk, or haemodynamic decompensation, the stenosis is considered clinically severe and structured treatment is warranted.
Therapy targets volume overload and heart rate control to relieve symptoms, drawing on several classes of medical agents. Anticoagulation is an additional management consideration, with agent selection and targets determined by the presence of atrial fibrillation and the extent of valve area reduction — the complete regimen and decision algorithm are available in the full protocol.
Improvement of symptoms through effective control of volume overload and heart rate.
References
- Patient with rheumatic mitral stenosis and mitral valve area ≤1.5 cm².
- An MVA of ≤1.5 cm² in conjunction with clinical factors (symptoms, high risk of thromboembolism, or haemodynamic decompensation) is indicative of clinically severe MS.
- Diuretics, beta-blockers, digoxin, non-dihydropyridine calcium channel blockers, and ivabradine can improve symptoms by controlling volume overload and heart rate.
- Anticoagulation with a VKA with a target international normalized ratio (INR) between 2 and 3 is indicated in patients with AF, and DOACs should be avoided in patients with an MVA of ≤2.0 cm² according to current evidence.