Wilkins Score (Mitral Valvuloplasty): Echocardiographic score used to predict the outcome of PMBV in patients with Rheumatic Mitral Stenosis.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Assessment of Rheumatic Mitral Stenosis (MS) suitability for Percutaneous Mitral Balloon Valvuloplasty (PMBV).
To predict the immediate result and long-term durability of the valvuloplasty procedure.
Absolute Contraindications to PMBV
Presence of Left Atrial (LA) thrombus or Moderate-to-Severe Mitral Regurgitation (MR). Even if the Wilkins score is low, these findings preclude the percutaneous approach.
Section 2
Formula & Logic
Scoring Components
The score evaluates four specific morphologic features of the mitral valve on a scale of 1 to 4:
Criteria
01
Mobility: Refers to the motion of the leaflets.
02
Subvalvular Thickening: Refers to the thickening and fusion of the chordae tendineae and papillary muscles.
03
Leaflet Thickening: Refers to the thickening of the leaflet tissue itself.
04
Calcification: Refers to the presence and extent of echocardiographic brightness (calcification).
Interpretation
Score ≤ 8: High likelihood of success (>90%).
Score 9–11: Intermediate likelihood; procedure may be attempted with caution.
Score ≥ 12: Low likelihood of success; higher risk of severe MR or technical failure.
Section 3
Pearls/Pitfalls
Cormier Score Alternative
While the Wilkins score is the international standard, the Cormier score is sometimes used in Europe. It focuses more heavily on the degree of calcification and subvalvular involvement, which are the primary drivers of PMBV failure.
Commissural Calcification
Modern refinements to the Wilkins score suggest that the presence of calcium IN THE COMMISSURES is more predictive of poor outcome than overall leaflet calcium. A "low" Wilkins score with commissural calcium may still lead to procedural failure.
Section 4
Evidence Appraisal
Original Validation
The echocardiographic prediction of the anatomic outcome of percutaneous mitral valvuloplasty.
Wilkins GT et al. • J Am Coll Cardiol.. 1988;12(1):25-31. The seminal study establishing the scoring system.
