Mitral Stenosis Treatment

Management of mitral stenosis is based primarily on the development of symptoms and pulmonary hypertension rather than the severity of the stenosis itself. Treatment options for mitral stenosis include enlarging the mitral valve or cutting the band of mitral fibers.

Procedures include:

Percutaneous balloon mitral valvotomy.
Surgical commissurotomy.

Symptomatic improvement occurs almost immediately, but after 9 years, recurrent symptoms are present in approximately 60% of individuals.

Certification/Recertification — Post-Percutaneous Balloon Mitral Valvotomy

Waiting period

Minimum — 4 weeks

NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver:

Is asymptomatic.
Has clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.
Has experienced no thromboembolic complications.
Has experienced no pulmonary hypertension.
Meets the certification recommendations for the underlying condition.

Recommend not to certify if:

The driver has:

Thromboembolic complications.
Pulmonary hypertension (pulmonary pressure greater than 50% of systemic blood pressure).

Monitoring/Testing

The driver should have an annual cardiology evaluation which should include:

History.
Physical examination.
Electrocardiogram.
Chest X-ray.
Two-dimensional echocardiography with Doppler performed after the procedure and prior to discharge. The frequency of repeat echo-Doppler examinations is variable and depends upon the initial periprocedural outcome and the occurrence of symptoms.

Follow-up

The driver should have an annual medical examination.

Mitral Stenosis Recommendation Table (PDF)

Certification/Recertification — Post-Surgical Commissurotomy