Wilkins (Massachusetts General) mitral echo score

Wilkins score · PLAX and PSAX of the mitral valve; 2D and 3D TOE when uncertain

Normal range & thresholds

Four components, each 1–4: leaflet mobility, leaflet thickening, subvalvular thickening, calcification (total 4–16). ≤8 predicts a good result of balloon mitral valvuloplasty ^[45].

Pathophysiology

Balloon valvuloplasty works by splitting fused commissures; rigid, calcified, subvalvularly fused valves do not split and tear instead, causing severe MR ^[45].

Raised by

• Advanced rheumatic disease, older age

Lowered by

• Pliable young valves

Technique & pitfalls

• Score each component on the worst region; add commissural calcification and MR grade — the 2025 ESC/EACTS guideline lists unfavourable features for PMC ^[6].

Pseudo-change & artefact

• Gain and harmonics overstate thickness; 2D underestimates commissural calcium.

Treatment thresholds

• Symptomatic severe MS with favourable anatomy → PMC (class I); unfavourable → surgery ^[6,7].
• Contraindications to PMC: LA thrombus, >mild MR, severe/bicommissural calcification, absent commissural fusion ^[6].

Next step

• TOE to exclude LA appendage thrombus before PMC.

Drugs

None change anatomy.

Reversibility

Anatomy is fixed; restenosis after PMC is common over years.