Mitral Restenosis vs Inadequate Valvotomy

How will you differentiate mitral restenosis vs inadequate valvotomy?

From the clinical history, there should have been a sustained improvement of at least 2 classes of NYHA for at least 6 months after the mitral valvotomy to qualify for an adequate valvotomy. Earlier recurrence of symptoms could be due to an inadequate valvotomy. An initial transient improvement is not enough to qualify for a successful valvotomy as even a slight increase in mitral valve area will produce subjective improvement in a patient with critical mitral stenosis and pulmonary congestion.

Recurrence of symptoms after an initial sustained improvement can be due to mitral restenosis. Whether it is due to mitral restenosis or other causes, will be differentiated by clinical examination and investigations. Deterioration other than due to mitral restenosis can occur due progression of mitral regurgitation, worsening of other valvular lesions or even some other pathology unrelated to mitral stenosis.