Wilkins et al used a score to describe the severity of mitral stenosis. Although developed for echocardiography, it can be applied to gross examination of the leaflet. The authors are from the Massachusetts General Hospital (MGH).
Parameters:
(1) mobility of the mitral valve leaflets
(2) subvalvular thickening of the chordae tendineae
(3) valvular thickening
(4) valvular calcifications
Parameter
Finding
Points
mobility of valve leaflets
normal (highly mobile)
0
restricted at leaflet tips
1
luminal third of leaflet restricted
2
some motion in base, and valve moves forward in diastole
3
leaflets show no or minimal movement forward in diastole
4
subvalvular thickening
none
0
minimal just below leaflets
1
up to one third of the chordae length thickened
2
two thirds of chordae length thickened
3
extensive thickening of entire chordae length with shortening
4
valvular thickening
none
0
near normal (4 -5 mm)
1
moderate thickening of margins (5-8 mm) with mid-leaflets normal
2
moderate thickening of entire leaflet
3
marked thickening of all leaflet tissue (> 8 mm)
4
valvular calcifications
none
0
single focus
1
scattered areas along leaflet margin
2
areas in midportion of the leaflets
3
extensive throughout most or all of the leaflet tissue
4
where:
• Valvular calcifications are seen as areas of increased echo brightness on echocardiography.
total score =
= SUM(points for all 4 parameters)
maximum grade of change =
= MAX(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The higher the score the more severe the mitral stenosis.
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