1. Mitral stenosis

(1) Strong indications for symptomatic (NYHA functional class III-IV) patients with moderate or severe mitral stenosis, as follows: Mitral valve surgery (repair if possible) is indicated in situations where: ① Inability to perform percutaneous mitral balloon valvuloplasty; ② Left atrial thrombus persists despite anticoagulation, or is accompanied by moderate or severe mitral valvuloplasty. Percutaneous mitral balloon valvuloplasty is contraindicated in patients with cusp regurgitation; ③ Patients with certain surgical risks whose valve shape is not suitable for percutaneous mitral balloon valvuloplasty. Symptomatic patients with moderate to severe mitral regurgitation and moderate to severe mitral stenosis should undergo mitral valve replacement surgery unless surgical repair is available.

(2) Situations where there is reason to undergo mitral valve replacement surgery: NYHA functional classification I-II, severe mitral stenosis and severe pulmonary hypertension (pulmonary artery systolic pressure >60mmHg), and not suitable for ball surgery Patients undergoing mitral valvuloplasty or valve repair surgery

(3) Patients with asymptomatic, moderate to severe mitral valve stenosis who have reasonable grounds for mitral valve repair surgery and who have symptoms after receiving adequate anticoagulation therapy Recurrent embolic events and valve morphology suitable for plastic surgery.

2. Mitral valve prolapse and regurgitation

(1) Strong indications ① Symptomatic patients with acute severe mitral regurgitation. ②Patients with chronic severe mitral regurgitation and cardiac function class II, III or IV, without severe left ventricular dysfunction (severe left ventricular dysfunction is defined as ejection fraction <0.30) and/or end-systolic Patients with inner diameter >55mm. ③Patients with asymptomatic chronic severe mitral regurgitation, mild or moderate left ventricular dysfunction, ejection fraction 0.30-0.60, and/or end-systolic diameter ≥40 mm. ④ Most patients with severe chronic mitral regurgitation who require surgery are recommended to undergo mitral valve repair rather than mitral valve replacement. Patients should go to a surgical center with experience in mitral valve repair.

(2) Situations where there is reason to undergo mitral valve surgery ① Asymptomatic patients with chronic severe mitral regurgitation with good cardiac function (EF>60% and end-systolic diameter <40mm), In experienced surgical centers there is >90% chance of successful reconstruction without residual insufficiency. ②Asymptomatic patients with chronic severe mitral regurgitation and new onset atrial fibrillation or pulmonary hypertension (systolic blood pressure >50mmHg at rest or >60mmHg during exercise). ③Patients with severe mitral regurgitation caused by abnormal mitral valve itself, NYHA classification III-IV, severe left ventricular dysfunction (EF<30%, end-systolic diameter>55mm), are likely to have plastic surgery. The successful one.

(3) Situations that require careful consideration of mitral valve surgery ① Chronic severe mitral regurgitation caused by severe left ventricular dysfunction (EF<30%), despite active treatment Treatment for heart failure (including biventricular pacing) while maintaining NYHA class III-IV. ② Mitral valve surgery alone is not suitable for patients with mild or moderate mitral regurgitation. ③Mitral valve surgery is not suitable for patients who are asymptomatic and have good left ventricular function (EF>60% and end-systolic diameter <40mm) and who are highly suspicious of the feasibility of plastic surgery.