Criteria for mitral valvotomy includes all except?
**Core Concept**
Mitral valvotomy is a procedure used to treat mitral stenosis, a condition characterized by the narrowing of the mitral valve opening. The criteria for mitral valvotomy aim to select patients who will benefit from the procedure while minimizing risks. The criteria typically include a narrow valve area, significant symptoms, and a favorable valve morphology.
**Why the Correct Answer is Right**
The correct answer is based on the understanding of mitral valve anatomy and the pathophysiology of mitral stenosis. Mitral valvotomy is most effective in patients with a narrow valve area (< 2.5 cm²) and significant symptoms, such as dyspnea, fatigue, or palpitations. The procedure is also indicated in patients with a favorable valve morphology, characterized by a mobile valve leaflet and a small calcification.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it is not a contraindication for mitral valvotomy. In fact, patients with a wide valve area may not benefit from the procedure.
**Option B:** This option is incorrect because it is not a contraindication for mitral valvotomy. Patients with a calcified valve may still undergo the procedure, although it may be more challenging.
**Option C:** This option is incorrect because it is a contraindication for mitral valvotomy. Patients with a severely calcified valve are at high risk for complications during and after the procedure.
**Clinical Pearl / High-Yield Fact**
The "Goormaghtigh" sign, a characteristic echocardiographic finding, is indicative of a favorable valve morphology for mitral valvotomy. This sign is a key determinant in selecting patients for the procedure.
**Correct Answer:** C. A severely calcified valve is a contraindication for mitral valvotomy.