Evaluation before PMC

Clinical evaluation is the first step when deciding whether to operate or intervene. Under particular scrutiny here are functional disability and any possible risks with surgery.

The assessment of anatomy aims to eliminate contraindications and define prognostic considerations. Echographic assessment allows the classification of patients into anatomic groups with a view to predicting the results. Most authors use the Wilkins score (table 1) while others, like Cormier (table 2), use a more general assessment of valve anatomy.3 More recently, scores which take into account the uneven distribution of anatomic abnormalities, particularly in regard to commissural areas, have been developed. In fact, none of the scores available has been shown to be superior to any of the others, and we can only recommend the use of the score with which one is most familiar and at ease.