Mitral stenosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Mitral stenosis is a narrowing of the mitral valve orifice. Fusion of the leaflet commissures or encroachment by annular calcium reduces the orifice area. Usually occurs as a consequence of rheumatic fever in low- and middle-income countries but is more likely due to mitral annular calcification in high-income countries.
Causes decreased filling of the left ventricle, while simultaneously increasing left atrial pressure, producing the syndrome of heart failure.
As disease progresses, pulmonary hypertension and right heart failure occur.
Mild disease can be treated symptomatically with diuretics. Moderate to severe disease requires mechanical correction of the valve obstruction by valvotomy, valve repair, or valve replacement.

Transthoracic echocardiogram: long-axis view of a rheumatic mitral valve showing classic doming of the leaflets in diastole

From Siva A, Shah AM. Heart. 2005 Jan;91(1):e3. Used with permission

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Transthoracic echocardiogram: long-axis view of a rheumatic mitral valve showing classic doming of the leaflets in diastole
Short-axis view of left ventricle with flattening of the interventricular septum secondary to right ventricular pressure overload
Kerley B lines (horizontal lines in the left lower zone): a radiologic change of pulmonary venous hypertension
Gorlin formula. MVA, mitral valve area; CO, cardiac output; HR, heart rate; dfp, diastolic filling period (seconds); p1-p2, mean mitral gradient
Stages of mitral stenosis (rheumatic disease)

Citations

Key Articles

Stollerman GH. Rheumatogenic streptococci and autoimmunity. Clin Immunol Immunopathol. 1991 Nov;61(2 Pt 1):131-42.[Abstract]
Fawzy ME, Choi WB, Mimish L, et al. Immediate and long-term effect of mitral balloon valvotomy on left ventricular volume and systolic function in severe mitral stenosis. Am Heart J. 1996 Aug;132(2 Pt 1):356-60. [Abstract]
Writing Committee Members; Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb 2;77(4):e25-197.[Abstract][Full Text]
Wilkins GT, Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilation. Br Heart J. 1988 Oct;60(4):299-308. [Abstract][Full Text]
Palacios IF, Sanchez PL, Harrell LC, et al. Which patients benefit from percutaneous mitral balloon valvuloplasty? prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation. 2002 Mar 26;105(12):1465-71.[Abstract][Full Text]
Reyes VP, Raju Bs, Wynne J, et al. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. N Engl J Med. 1994 Oct 13;331(15):961-7. [Abstract][Full Text]
Subbarao KS, Nachiappan M, Irineu AP. Transventricular mitral commissurotomy in critical mitral stenosis during pregnancy. Asian Cardiovasc Thorac Ann. 2004 Sep;12(3):233-5.[Abstract]
Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis: developed by the task force on the management of endocarditis of the European Society of Cardiology (ESC) endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Nuclear Medicine (EANM). Eur Heart J. 2023 Oct 14;44(39):3948-4042.[Full Text]

Referenced Articles

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