Mean transmitral gradient thresholds for mitral stenosis severity are mild <5, moderate 5–10, severe >10. If planimetric MVA is 1.4 cm^2 and mean gradient is 9 mmHg, how would you categorize stenosis?

Mean transmitral gradient thresholds for mitral stenosis severity are mild <5, moderate 5–10, severe >10. If planimetric MVA is 1.4 cm^2 and mean gradient is 9 mmHg, how would you categorize stenosis?

• A. Moderate
• B. Mild
• C. Severe
• D. Indeterminate

Answer: (A)

The key idea is that both the gradient and the valve area help grade mitral stenosis, and they should ideally agree. A mean transmitral gradient of 9 mmHg falls within the moderate range of 5–10 mmHg. The planimetric MVA of 1.4 cm^2 also aligns with moderate stenosis (roughly 1.0–1.5 cm^2). When both measurements point to the same category, the classification is clear. So this case is moderate mitral stenosis. Note that gradients can be influenced by flow state, but here the rate and area concur, reinforcing the moderate designation.

The key idea is that both the gradient and the valve area help grade mitral stenosis, and they should ideally agree. A mean transmitral gradient of 9 mmHg falls within the moderate range of 5–10 mmHg. The planimetric MVA of 1.4 cm^2 also aligns with moderate stenosis (roughly 1.0–1.5 cm^2). When both measurements point to the same category, the classification is clear. So this case is moderate mitral stenosis. Note that gradients can be influenced by flow state, but here the rate and area concur, reinforcing the moderate designation.