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Table 4 Native valve follow-up: mitral stenosis and mitral regurgitation*

From: Clinical indications and triaging for adult transthoracic echocardiography: a consensus statement by the British Society of Echocardiography in collaboration with British Heart Valve Society

Mitral stenosis
Mild Moderate Severe
• Valve area > 1.5 cm2
• TTE every 3–5 years
• Valve area: 1.0–1.5 cm2
• TTE every 1–2 years
• Cardiologist review
• Valve area: < 1.0 cm2
• TTE every 6–12 months
• Cardiologist review
N.B. Valve area < 1.5 cm2 = clinically significant mitral stenosis where valve intervention can be considered if patient is symptomatic or, asymptomatic with high risk of embolism/decompensation or, positive exercise stress echocardiography
TTE alerts for urgent Cardiologist review:
• PA systolic pressure > 50 mmHg
• RV dysfunction
• Dense spontaneous contrast in the LA
Other alerts for Cardiologist review:
• Development of symptoms
• New AF
• TIA or stroke
Mitral regurgitation
Mild Moderate Severe
• TTE every 3–5 years if mild prolapse
• No follow up usually required if normal mitral valve appearance
• TTE every 1–2 years
• Cardiologist review
• TTE every 6–12 months
• Cardiologist review at 6 months
TTE alerts for urgent Cardiologist review:
• LVEF < 60%
• LV systolic dimension approaching 45 mm
• Severe LV volume dilatation
• MR secondary to flail leaflet
• PA systolic pressure > 50 mmHg
• Severe MR with LA volume ≥ 60 ml/m2 and patient in sinus rhythm
Other alerts: Cardiologist review:
• Development of symptoms
• New AF
  1. AF (atrial fibrillation), AR (aortic regurgitation), AS (aortic stenosis), cm2 (centimetres squared), LA (left atrial), LV (left ventricular), LVEF (left ventricular ejection fraction), mm (millimetres), MR (mitral regurgitation), m/s (meters per second), PA: pulmonary artery, RV (right ventricular),TIA (transient ischemia attack), TTE (Transthoracic echocardiography), Vmax (maximum velocity)
  2. *Adapted from Baumgartner et al. 2017 [13] and Chambers et al. 2017 [14]