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Wilkins Score Intermediate Zone — EECC MCQ

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ModerateValvular Heart DiseaseWilkins Score Intermediate ZoneEECC

A 60-year-old woman with severe symptomatic mitral stenosis (MVA 0.9 cm²) due to rheumatic disease has a Wilkins echocardiographic score of 10/16. She has moderate subvalvular disease and mild MR. Is she suitable for PMBC?

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Correct answer: D — Borderline suitability — a Wilkins score of 9-11 represents an intermediate zone where PMBC may still be attempted if surgical risk is high, but results are less predictable than scores ≤8; surgical MVR is the alternative

The Wilkins echocardiographic score (4-16) assesses leaflet mobility, thickening, calcification, and subvalvular disease (each 1-4). Scores ≤8: excellent PMBC outcomes (Class I); scores 9-11: intermediate — PMBC may be attempted but results are less predictable (larger post-procedure MVA, higher complication rate); scores ≥12: unfavourable — PMBC generally not recommended (higher failure rate, more MR). The 2025 ESC VHD Guidelines advise individualised decision-making for intermediate scores, considering: surgical risk, operator experience, anatomical details (commissural calcification is particularly unfavourable), and patient preference. In this patient with score 10, mild MR (not moderate-severe), and high surgical risk, PMBC may still be reasonable with appropriate counselling about suboptimal results.

Reference: ESC/EACTS (2025): VHD Guidelines