Echocardiographic criteria in selection of patients for percutaneous mitral commissurotomy

The purpose of this report is to review the role of echocardiography in the selection of patients for percutaneous mitral commissurotomy (PMC). Echoca rdiography has become the standard for the assessment of the severity of mi tral stenosis and of its consequences. PMC is usually performed only in pat ients with a valve area of < 1.5 cm(2), whereas pulmonary hypertension or s pontaneous echo contrast in the left atrium may lead to intervention in pat ients with few symptoms. The next step of the echocardiographic evaluation is to eliminate contraindications: left atrial thrombosis (by the systemati c performance of a transesophageal examination before PMC), mitral regurgit ation greater than or equal to 2/4, severe aortic valve disease, mixed tric uspid valve disease, and massive or bicommissural calcification. Finally, e chocardiography allows the classification of patients into different anatom ic groups for prognostic consideration. There is controversy regarding the best echo score system in the prediction of the results of PMC. Scores usin g a global evaluation of the value anatomy are the most widely used, wherea s more recently, scores taking into account the uneven distribution of the disease have had promising preliminary results. Overall, echo scores are us eful criteria for selecting candidates for PMC, but they should be consider ed together with the other clinical and procedural variables. Thus, echocar diography has an important role in, the selection, of patients for PMC, as well as for the guidance of the procedure, the evaluation of the results, a nd surveillance.