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. Author manuscript; available in PMC: 2016 Oct 18.
Published in final edited form as: Anesth Analg. 2016 Jul;123(1):14–20. doi: 10.1213/ANE.0000000000001276

Table 3.

Summary Comparison of Rheumatic and Degenerative Mitral Stenosis

Rheumatic mitral stenosis Degenerative mitral stenosis
Prevalence with age Any age >5 y Increasing with advanced age
Pathophysiology Autoimmune cross-reactivity with Strep A antigen; inflammatory tissue damage Degenerative (age) or disordered calcium metabolism
Qualitative assessment Chordal shortening Annular calcification
Leaflet thickening Sparing of leaflet tips and subvalvular apparatus unless advanced
Reduced leaflet mobility (posterior > anterior) Calcific shadowing
Commissural fusion (3D TEE)
Quantitative assessment 2D planimetry 2D planimetry—may be unreliable
3D planimetry; pressure gradients 3D planimetry; pressure gradients—may be unreliable
MVA by PHT MVA by PHT—may be unreliable
MVA by continuity equation MVA by continuity equation
MVA by PISA MVA by PISA
Associated findings Aortic regurgitation tricuspid regurgitation (functional) Aortic stenosis; LVH; hypertension
Infective endocarditis Diastolic dysfunction

2D = two-dimensional; 3D = three-dimensional; LVH = left ventricular hypertrophy; MVA = mitral valve area; PHT = pressure half-time; PISA = proximal isovelocity surface area; TEE = transesophageal echocardiography.