Wilkins echocardiographic score for mitral stenosis

Wilkins echocardiographic score for mitral stenosis


Wilkins echocardiographic score for mitral stenosis is useful for deciding whether the valve is suitable for balloon mitral valvotomy (BMV), also known as PTMC (percutaneous trans-mitral commissurotomy). The score was developed based on the first 22 patients who underwent balloon mitral valvotomy at their center.

Four parameters considered in Wilkins score are: leaflet mobility, leaflet thickening, leaflet calcification and sub valvar apparatus [1]. Each parameter is graded 1-4 depending on the severity. Total score possible is 16. A score up to 8 is considered ideal for BMV/PTMC. When the score is higher, the chance of significant mitral regurgitation as a complication of BMV is more likely.

Regarding mobility, in grade 1, leaflet is highly mobile with only leaflet tip movement restricted. In grade 4, there is minimal or no movement. Other grades are in between.

On the thickness aspect, leaflet thickness is near normal, 4-5 mm. In grade 4, there is considerable thickening of the whole leaflet, 8-10 mm or more. Grade 2 and 3 are in between.

In grade 1 for calcification, there is only a single area of echo brightness. In grade 4, there is extensive brightness through out most of the leaflet tissue. Intermediate grades are in between.

Grade 1 of subvalvar thickening is just a single area of increased echo brightness. In grade 4, there is extensive thickening and shortening of all chordal structures down to the papillary muscles. Patterns in between are seen for the other grades.

Various other scoring systems have been proposed later for the assessment of mitral valve. These were by Chen et al [2], Reid score [3], Nobuyoshi score [4],  and Cormier score [5]. With the onset of 3D echocardiography, scores based on 3D echo has also been proposed [6]. 3D grading might overcome the difficulty in differentiating between calcification and nodular fibrosis.

References

  1. G T Wilkins, A E Weyman, V M Abascal, P C Block, I F Palacios. Percutaneous Balloon Dilatation of the Mitral Valve: An Analysis of Echocardiographic Variables Related to Outcome and the Mechanism of Dilatation. Br Heart J. 1988 Oct;60(4):299-308.
  2. Chen CG, Wang X, Wang Y, Lan YF. Value of two-dimensional echocardiography in selecting patients and balloon sizes for percutaneous balloon mitral valvuloplasty. J Am Coll Cardiol. 1989 Dec;14(7):1651-8.
  3. Reid CL, Chandraratna PA, Kawanishi DT, Kotlewski A, Rahimtoola SH. Influence of mitral valve morphology on double-balloon catheter balloon valvuloplasty in patients with mitral stenosis. Analysis of factors predicting immediate and 3-month results. Circulation. 1989 Sep;80(3):515-24.
  4. Nobuyoshi M, Hamasaki N, Kimura T, Nosaka H, Yokoi H, Yasumoto H, Horiuchi H, Nakashima H, Shindo T, Mori T, et al. Indications, complications, and short-term clinical outcome of percutaneous transvenous mitral commissurotomy. Circulation. 1989 Oct;80(4):782-92.
  5. Iung B, Cormier B, Ducimetière P, Porte JM, Nallet O, Michel PL, Acar J, Vahanian A. Immediate results of percutaneous mitral commissurotomy. A predictive model on a series of 1514 patients. Circulation. 1996 Nov 1;94(9):2124-30.
  6. Soliman OI, Anwar AM, Metawei AK, McGhie JS, Geleijnse ML, Ten Cate FJ. New Scores for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography. Curr Cardiovasc Imaging Rep. 2011 Oct;4(5):370-377.