Treatment-mitral-stenosis

• Medical: Na restriction, cautious diuresis, βB, AF control, sx-limited physical stress
• Antibiotic Ppx recommended if h/o RHD w/ valvular disease for 10 y or until age 40
• Anticoag w/ warfarin (not DOAC) if: AF; prior embolism; LA clot
• Mechanical intervention indicated if sx severe MS; reasonable if asx severe MS but PASP >50 mmHg and morphology favorable for PMBC; consider PMBC if non-severe MS but exertional sx and hemodyn signif w/ exercise, or if asx severe MS and new-onset AF
• Percutaneous mitral balloon commissurotomy (PMBC): preferred Rx if RHD; ≈ MVR if valvuloplasty score <8, Ø if mod-severe MR or LA clot
• Surgical (MV repair if possible, o/w replacement) if PMBC contraindicated
• Calcific MS: surgical MVR if severe & highly sx; use of transcatheter aortic prosthesis experimental and w/ high rate of complications (Circ CVI 2020;13:e008425)
• Pregnancy: if NYHA class III/IV → PMBC, o/w medical Rx w/ low-dose diuretic & βB