Table 3.

Indications for cardiac surgery in RHD

Condition	Patient group	Criteria
Severe mitral regurgitation	Adults	• Severe mitral regurgitation with symptoms (NYHA class 2–4) and an LVEF of >30% • Asymptomatic mitral regurgitation and one of the following: LVESD of ≥40 mm, impaired left ventricular function with an LVEF of >30% and <60%, pulmonary hypertension of >50 mmHg or new onset atrial fibrillation • Moderate to severe mitral regurgitation with an LVEF of >60% and an LVESD of <40 mm, and only if the valve is judged to have a high likelihood of repair
	Children	• Severe mitral regurgitation with symptoms of breathlessness • Asymptomatic mitral regurgitation and one of the following: impaired left ventricular function of <60%, an LVESD z-score of ≥2.5 mm or pulmonary hypertension of >50 mmHg
Mitral stenosis*	Adults and children	• Severe mitral stenosis with symptoms (NYHA class 2–4) • Asymptomatic severe mitral stenosis and one of the following: paroxysmal atrial fibrillation, a mitral valve area of <1.5 cm2, pulmonary hypertension of >50 mmHg or thromboembolism
Severe aortic regurgitation	Adults	• Symptoms NYHA class 2–4 • Asymptomatic severe aortic regurgitation and one of the following: an LVESD of ≥50 mm, impaired left ventricular function with an LVEF of <50% or a LVEDD of >65 mm
	Children	• Symptoms • Asymptomatic severe aortic regurgitation with an LVESV z-score of >4 and impaired left ventricular function with an LVEF of <50%

LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; LVESV, left ventricular end-systolic volume; NYHA, New York Heart Association; RHD, rheumatic heart disease.

^*Mitral valvuloplasty or cardiac surgery is recommended.