Management of mitral stenosis using 2D and 3D echo-Doppler imaging

JACC Cardiovasc Imaging. 2013 Nov;6(11):1191-205. doi: 10.1016/j.jcmg.2013.07.008.


Although the prevalence of rheumatic fever is decreasing in developed countries, it still affects numerous areas in the nonindustrialized world. Untreated mitral stenosis (MS) contributes to a significant global morbidity and mortality. Echocardiography is the main diagnostic imaging modality with which to evaluate mitral valve (MV) obstruction and assess the severity and hemodynamic consequences of MS as well as valve morphology. According to current guidelines and recommendations for clinical practice, the severity of MS should not be defined by a single value but assessed by valve areas, mean Doppler gradients, and pulmonary pressures. Transthoracic echocardiography is usually sufficient to grade MS severity and to define the morphology of the valve. Transesophageal echocardiography is used when the valve cannot be adequately assessed with transthoracic echocardiography and to exclude intracardiac thrombi before a percutaneous or surgical intervention. Three-dimensional transthoracic and transesophageal echocardiographic assessment provide more detailed physiological and morphological information. Current definitive treatment for severe MS involves percutaneous mitral balloon valvuloplasty (PMBV) or surgery. The effectiveness of PMBV is related to the etiology of MS, and certain anatomic characteristics tend to predict a more successful outcome for PMBV, whereas other MV structural findings might suggest balloon valvuloplasty to be less likely successful or even contraindicated.

Keywords: 2-dimensional; 2D; 3-dimensional; 3D; IAS; MR; MS; MV; MVA; PHT; PISA; PMBV; RF; RT-TT3DE; TEE; TTE; echocardiography; interatrial septum; mitral regurgitation; mitral stenosis; mitral valve; mitral valve area; percutaneous intervention; percutaneous mitral balloon valvuloplasty; pressure half-time; proximal isovelocity surface area; real-time 3-dimensional transthoracic echocardiography; rheumatic fever; rheumatic heart disease; transesophageal echocardiography; transthoracic echocardiography.

Publication types

  • Review

MeSH terms

  • Balloon Valvuloplasty
  • Cardiac Surgical Procedures
  • Echocardiography, Doppler, Color*
  • Echocardiography, Three-Dimensional*
  • Echocardiography, Transesophageal*
  • Hemodynamics
  • Humans
  • Mitral Valve / diagnostic imaging*
  • Mitral Valve / physiopathology
  • Mitral Valve Stenosis / diagnostic imaging*
  • Mitral Valve Stenosis / physiopathology
  • Mitral Valve Stenosis / therapy*
  • Patient Selection
  • Predictive Value of Tests
  • Rheumatic Heart Disease / diagnostic imaging*
  • Rheumatic Heart Disease / physiopathology
  • Rheumatic Heart Disease / therapy*
  • Severity of Illness Index
  • Treatment Outcome