Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Mitral Stenosis (MS) 995

No significant MR

No significant calcifications in MV leaflets

Only mild leaflet thickening

Miminal subvalvular apparatus involvement

No thrombus in left atrium

➣(Surgical MV replacement indicated, if any one of above not

met)

follow-up

n/a

complications and prognosis

Complications

■Percutaneous balloon valvotomy

➣Acute

Systemic emboli 4–8% (thrombus or calcified debris)

Severe MR requiring immediate MV replacement 2–3% (Care-

ful selection using TEE data is essential to avoid this compli-

cation)

Left to right atrial shunt (usually small, non-significant)

LV perforation resulting in cardiac tamponade 2–4%

➣Long-term

Excellent long-term results in younger patients, without atrial

fibrillation, and careful selection by TEE (see above criteria)-

5% restenosis at 32 months follow-up

■Surgical replacement of mitral valve

➣Acute

Complications associated with cardiopulmonary bypass

surgery

➣Long-term

Bleeding due to warfarin therapy

Endocarditis

Malfunction of mechanical or bioprosthetic mitral valve

Thromboembolism

Prognosis

■Slow progression from Class II to Class III/IV over 5–10 years

■Class III and IV medical treatment survival worse versus interven-

tional or surgical groups

■Overall prognosis good in surgical and interventional groups unless

severe right heart failure present