Sandbox/MS
Abbreviations: CABG: coronary artery bypass graft; ECG: electrocardiogram; LAD: left anterior descending; LBBB: left bundle branch block; MI: myocardial infarction; PCI: percutaneous coronary intervention; S3: third heart sound; S4: fourth heart sound; VSD: ventricular septal defect
Administer ONE of the following antiplatelet agents (before or at the time of PCI): 
 P2Y12 receptor inhibitors
Prasugrel is contraindicated in case of prior history of strokes or TIAs, active pathological bleeding, age 75 years, when urgent coronary artery bypass graft surgery (CABG) is likely, body weight <60 kg, propensity to bleed, concomitant use of medications that increase the risk of bleeding  
 IV GP IIb/IIIa inhibitors
Administer ONE of the following anticoagulant therapy:
 Unfractionated heparin
 Bivalirudin
G01=
 Ongoing and recurrent ischemia 
 Cardiogenic shock 
 Severe heart failure 
 Other high risk features

# Summary of Recommendations for Mitral Stenosis Intervention
- PMBC is recommended for symptomatic patients with sever mitral stenosis (MVA  1.5 cm2, stage D) and favorabale valve morphology in the absence of contraindications (Class I, level of evidence A)
- Mitral valve surgery is indicated in severely symptomatic patients (NYHA class III/IV) with severe mitral stenosis (MVA  1.5 cm2, stage D) who are not high risk for surgery and who are not candidates for or failed previous PMBC (Class I, level of evidence B)
- Concomitant mitral valve surgery is indicated for patients with severe mitral stenosis (MVA  1.5 cm2, stage C or D) undergoing other cardiac surgery (Class I, level of evidence C)
- PMBC is reasonable for asymptomatic patients with very severe mitral stenosis (MVA  1 cm2, stage C)  and favourable valve morphology in the absence of contraindications (Class IIa, level of evidence C)
- Mitral valve surgery is reasonable for severely symptomatic patients with severe mitral stenosis (MVA  1.5 cm2, stage D) provided that there is other operative indications (Class IIa, level of evidence C)
- PMBC may be considered for asymptomatic patients with mitral stenosis (MVA  1.5 cm2, stage C) and favourable valve morphology who have new onset of atrial fibrillation in the absence of contraindications (Class IIb, level of evidence C)
- PMBC may be considered for symptomatic patients with MVA > 1.5 cm2 if there is evidence of hemodynamically significant mitral stenosis during exercise (Class IIb, level of evidence C)
- PMBC may be considered for severely symptomatic patients (NYHA III/IV) with severe mitral stenosis (MVA  1.5 cm2, stage D) who have suboptimal valve anatomy and aren't candidates for surgery or at high risk for surgery (Class IIb, level of evidence C)
- Concomitant mitral valve surgery may be considered for patients with moderate mitral stenosis (MVA 1.6 - 2.0 cm2) undergoing other cardiac surgery (Class IIb, level of evidence C)
- Mitral valve surgery and excision of the left atrial appendage may be considered for patients with severe mitral stenosis (MVA  1.5 cm2, stage C and D) who have recurrent embolic events while receiving adequate anticoagulation (Class IIb, level of evidence C)
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