Abstract：
A number of guidelines exist with recommendations for diagnosis and management of mitral stenosis (MS). We systematically reviewed existing guidelines for diagnosis and management of MS, highlighting their similarities and differences, in order to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (5/4/2011-5/9/2021), the Guidelines International Network, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two independent reviewers screened titles and abstracts, and the full text of potentially relevant articles where needed. Selected guidelines were assessed for rigor of development; only guidelines with Appraisal of Guidelines for Research and Evaluation II instrument score >50% were included in the final analysis. Four guidelines were retained for analysis. There was consensus for percutaneous mitral balloon commissurotomy as first-line treatment of symptomatic severe rheumatic MS with suitable anatomy. In patients with unfavourable anatomy, surgical intervention should be considered. Exercise testing is indicated if discrepancy exists between symptoms and echocardiographic measurements. There was no clear divide between rheumatic MS and degenerative MS for their respective diagnoses and management. Pregnancy in severe MS is discouraged and the stenosis should be treated before conception. Long-term antibiotic prophylaxis is recommended for patients with rheumatic MS. Recommendations for the management of patients with mixed valvular diseases are lacking.
摘要：
存在许多关于二尖瓣狭窄（MS）的诊断和管理的指南。我们系统地回顾了现有的MS诊断和管理指南，突出它们的异同,以指导临床决策。我们搜索了MEDLINE和EMBASE的国家和国际指南（5/4/2011-5/9/2021），准则国际网络，指南图书馆，国家准则信息交换所，国家图书馆健康指南查找器，加拿大医学协会临床实践指南信息库，和相关组织的网站。两名独立审稿人筛选了标题和摘要，以及可能需要的相关文章的全文。对选定的指南进行了严格的开发评估；最终分析中只包括具有评估和评估II仪器评分的指南50％。保留了四个指南进行分析。经皮二尖瓣球囊连合切开术作为有症状的重度风湿性MS的一线治疗具有适当解剖结构的共识。在解剖结构不佳的患者中，应考虑手术干预。如果症状和超声心动图测量结果之间存在差异，则应进行运动测试。风湿性MS和退行性MS在各自的诊断和管理方面没有明显的区别。不鼓励重度MS患者怀孕，应在受孕前治疗狭窄。建议对风湿性MS患者进行长期抗生素预防。缺乏关于混合瓣膜疾病患者管理的建议。
