Mitral Stenosis: Assessment of Valve Area by Planimetry, PHT, Continuity, and Wilkins Score
Planimetry of the Mitral Valve Area
When the excursion of the mitral valve leaflets is limited, the MVA should be calculated using the planimetric method [Blagodir, 2024]. Planimetry of the mitral valve orifice has a high correlation with anatomical MVA, which normally measures 4–5 cm² [Blagodir, 2024].
Clinical significance of the indicator: most patients with MS remain asymptomatic as long as the MVA exceeds 1.5 cm² [Blagodir, 2024].
Assessment of Leaflets for Exclusion of Pathology
The anterior (AML) and posterior (PML) leaflets of the mitral valve are normally thin, elastic, and open without restriction; the AML is longer and more mobile than the PML [Blagodir, 2024]. When assessing the mitral valve, it is necessary to exclude [Blagodir, 2024]:
| Feature for Exclusion |
|---|
| Prolapse/elongation of leaflets |
| Myxomatous/thickening/calcification with/without restricted excursion |
| Flail leaflet/chordae/papillary muscles |
| Calcification of the mitral annulus (MV annulus) |
Additionally, it is recommended to assess color flow Doppler mapping (CFD) in the parasternal SAX BASAL view to exclude mitral stenosis, mitral regurgitation, and ventricular septal defect [Blagodir, 2024].
PHT, Continuity, and Wilkins Score
The EAE/ASE 2009 recommendation block indicates that the assessment of mitral stenosis falls under the section "Indices of Stenosis Severity"; however, specific PHT threshold values for MVA, details of the continuity method as applied to the mitral valve, and the Wilkins score are not provided in the source fragments [clarify].
Also, in the context of assessing transaortic blood flow volume according to EAE/ASE 2009, mitral stenosis is listed as one of the causes of flow reduction, along with stroke volume of the LVOT, SV, and LVEF by 2D, as well as the severity of MR [Baumgartner et al., 2009].
Frequently asked questions
What is the normal mitral valve area and when do MS symptoms appear?
Normally, the MVA is 4–5 cm². Most patients with mitral stenosis are asymptomatic as long as the MVA exceeds 1.5 cm² [Blagodir, 2024].
When should the MVA be calculated using the planimetric method?
When the excursion of the mitral valve is restricted, the MVA is calculated using the planimetric method; it has a high correlation with anatomical MVA [Blagodir, 2024].
What should be excluded when assessing the mitral valve?
Prolapse/elongation of leaflets, myxomatous/thickening/calcification with/without restricted excursion, flail leaflet/chordae/papillary muscles, and calcification of the mitral annulus [Blagodir, 2024].
Are PHT thresholds and the Wilkins score for MS provided in the fragments?
No. Specific PHT threshold values for mitral stenosis, the continuity method for the mitral valve, and the Wilkins score are not present in the provided fragments [clarify].