NHS Western Isles guidelines - In development
We would welcome referrals of patients with mitral stenosis or paravalvular leaks who fit the following criteria:
Mitral Stenosis
Essential Criteria:
- Symptoms of Heart Failure due to mitral stenosis
- OR, high risk of embolism
- OR, symptom limited exercise test
- AND, clinically significant mitral stenosis (MVA < 1.5 cm2)
- IF, no unfavourable clinical or anatomical characteristics
- OR, high risk for valve surgery
Contraindications:
- Unfavourable clinical or anatomical characteristics (unless high surgical risk)
- Left atrial thrombus
- More than mild mitral regurgitation
- Bi-commissural calcification
- Absence of commissural fusion
- Severe concomitant aortic or tricuspid valve disease requiring surgery
- Concomitant coronary disease requiring surgery
Paravalvular Leak
Essential Criteria:
- Symptoms of heart failure secondary to PVL
- OR, Severe mechanical haemolysis requiring transfusion
- AND, Clinically significant aortic or mitral paravalvular regurgitation (Grade 3/4 or 4/4)
Contraindications:
- Low surgical risk (re-do valve replacement preferred)
- Major dehiscence of the prosthetic valve
- Active infective endocarditis
- Severe concomitant valve disease requiring surgery
- Concomitant coronary disease requiring surgery
