Rheumatic Mitral Stenosis: Update in Diagnosis and Evaluation

Rheumatic heart disease (RHD) is the predominant cause of mitral stenosis (MS) worldwide. This review provides an overview of MS diagnosis, assessing disease severity, and the hemodynamic impact of valve obstruction. Additionally, it examines different echocardiographic parameters and scoring systems employed to evaluate mitral valve morphology and determining suitability for percutaneous mitral commissurotomy (PMC).

Echocardiography remains the cornerstone for diagnosing and assessing MS severity, while also evaluating valve morphology for potential interventions. Three-dimensional echocardiography planimetry is increasingly used in clinical practice as an as accurate method to measure the true mitral orifice area. Net atrioventricular compliance assessment can be useful for risk stratification, particularly in the presence of a discrepancy between anatomic severity and functional status. Speckle tracking echocardiography emerges as an innovative tool for early detection of left atrial dysfunction, predicting the onset of atrial fibrillation, and adverse outcomes in MS patients. Cardiac magnetic resonance imaging, with its multiparametric analysis, stands as one of the beneficial imaging methods in selected cases.

Individualized approaches based on symptoms, MS severity, mitral valve morphology are essential for precise management strategies that can improve patient outcomes.