Figure 1.

Management of clinically significant mitral stenosis. ¹Thromboembolism: past embolism, atrial fibrillation, dense echo in left atrium; ²decompensation: pulmonary hypertension > 50 mmHg, major noncardiac operation, intention for pregnancy; ³Consider commissurotomy by experienced surgeons or in patients contraindicated for PBMV; ⁴Mitral valve orifice <1.5 cm², no left atrium clots, MR < grade 2, mild calcification, no fused commissures; ⁵PBMV for symptomatic patients contraindicated to operation, mitral valve operation for symptomatic patients unsuitable for PBMV; ⁶Surgery if symptomatic at less physical activity and low surgical risk. For the strength of recommendation: class I means the procedure should be performed, class IIa means it is reasonable to perform the procedure, and class IIb means the procedure may be considered (Redrawn from: Baumgartner et al ²¹ and Nishimura et al ²² 161 × 207mm (300 × 300 DPI)