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Mitral Valve Stenosis

Definition


Disease: Mitral Valve Stenosis Mitral Valve Stenosis
Category: Cardiovascular diseases
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Disease Definition:

The condition in which the heart's mitral valve is narrowed (stenotic) is called mitral valve stenosis or mitral stenosis. Obstructing blood flow through the heart and from the heart to the rest of the body, this narrowing blocks the valve from opening properly. Mitral valve stenosis can make a person short of breath and tired in addition to other problems.

A childhood infection called rheumatic fever, which is related to strep infections, is the main cause of mitral valve stenosis. The mitral valve can be scarred by rheumatic fever, which is still prevalent in developing countries.

In people of all ages, mitral valve stenosis is treatable. However, stenosis can lead to serious heart complications when it is left untreated.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

One may have only minimal signs and symptoms of mitral valve stenosis for decades or he/she can have the condition and feel well. However, mild problems can suddenly get worse. When developing these mitral valve stenosis symptoms, a person should see the doctor:

 

  • Heart palpitations, which are sensations of a rapid, fluttering heartbeat
  • Heavy coughing, sometimes with blood-tinged sputum
  • Shortness of breath, especially with exertion or when lying down
  • Fatigue, especially during times of increased activity
  • Rarely, chest discomfort or chest pain
  • Swollen feet or ankles
  • Frequent respiratory infections, such as bronchitis


Mitral valve stenosis symptoms — which may resemble those of other heart or heart valve conditions — may appear or worsen anytime a person increases his/her heart rate, such as during exercise. These symptoms may be accompanied with an episode of rapid heartbeats as well. Pregnancy or other stress on the body such as a respiratory infection or heart infection may also trigger those symptoms.

Symptoms of heart failure, a complication of mitral valve stenosis and other heart problems are usually included in the symptoms of mitral valve stenosis. Resulting in fluid buildup (congestion) and shortness of breath, pressure that builds up in the heart is then sent back to the lungs in mitral valve stenosis.

When a person is in his/her 40s and 50s, symptoms of mitral valve stenosis most often appear, however they can occur at any age, even during infancy.  A child or an infant with mitral valve stenosis may have no symptoms, may tire easily or may have shortness of breath with vigorous physical activity, depending on the amount of narrowing.

A number of signs that only the doctor will be able to find, may be produced by mitral valve stenosis. These signs may include:

 

  • Blood clots
  • Lung congestion
  • Pulmonary hypertension
  • Heart murmur
  • Irregular heart rhythms (arrhythmias)


If a person develops symptoms such as chest pain, heart palpitations or fatigue or shortness of breath, this patient should immediately see a doctor.

The patient should talk to the doctor about recommended follow-up, if he/she has been diagnosed with mitral valve stenosis but hasn't had symptoms. 

Causes:

The center of the circulatory system, which is the heart, consists of four chambers, while the atria, the two upper chambers, receive blood. The ventricles, the two lower chambers, pump blood.

Aided by four heart valves, blood flows through the heart's chambers. To let blood flow in only one direction through the heart, these valves open and close:

 

  • Tricuspid valve
  • Pulmonary valve
  • Mitral valve
  • Aortic valve


Two triangular-shaped flaps of tissue called leaflets form the mitral valve, which lies between the two chambers on the left side of the heart. Through a ring called the annulus, the leaflets of the mitral valve connect to the heart muscle. Anchoring the mitral valve to the left ventricle are tendon-like cords called chordae tendineae cordis, which resemble the strings of a parachute.

Heart valves open like a trapdoor. When blood flows from the left atrium into the left ventricle, the mitral valve is forced open. To prevent the blood that has just passed into the left ventricle from flowing backward in the wrong direction, the leaflets swing closed when all of the blood has gone through the valve.

The heart valve that fails to either open or close fully is a defective one. Blood can flow backward when a valve doesn’t close tightly. Regurgitation (insufficiency) is what we call this backward flow through a valve. The condition is called stenosis when a valve becomes narrowed and blood flow through it becomes limited.

Narrowing of the mitral valve is called mitral valve stenosis. Obstructing blood flow into the heart's left ventricle, many factors can tighten this passageway between the heart's left-sided chambers. The following are included in the causes of mitral valve stenosis:

Congenital Heart Defect:
Babies are born with a narrowed mitral valve and develop mitral valve stenosis early in life in some rare cases. To fix the valve, babies born with this problem usually require heart surgery. Other babies are born with a damaged mitral valve that puts them at risk of developing mitral valve stenosis when they're older. It's not something that can be prevented, as doctors don't know why a heart valve fails to develop properly in a newborn, infant or child.

Rheumatic Fever:
Leading to mitral valve stenosis later in life, a complication of strep throat infection called rheumatic fever can damage the mitral valve. The most common cause of mitral valve stenosis is rheumatic fever. This condition can damage the mitral valve in two main ways. Preventing the valve from opening and closing properly, the infection may cause the leaflets of the mitral valve to fuse somewhat together; or limiting the valve's ability to open, the infection may cause the leaflets of the valve to thicken. Both mitral valve regurgitation and mitral valve stenosis may be experienced by people with rheumatic fever.

Other Causes:
Rarely, growths, blood clots or tumors can block the mitral valve, mimicking mitral valve stenosis. As a person ages, excessive calcium deposits can build up around the mitral valve, which sometimes causes significant mitral valve stenosis. Radiation treatment to the chest and some medications also may cause mitral valve stenosis.

In countries where antibiotic use isn't as common, rheumatic fever remains a frequent problem.

A history of rheumatic fever and recurrent strep infections are included in the risk factors for mitral valve stenosis. Mitral valve stenosis can be the result of radiation treatment involving the chest. Medications such as ergot preparations used for migraines may be included in other unusual causes of mitral valve stenosis.

Complications

Complications:

A narrowed mitral valve limits blood flow in the same way a narrow funnel spout limits the flow of fluid through a funnel, no matter what the cause is. Blood has a difficult time flowing from the left atrium to the left ventricle in mitral valve stenosis. The chamber may enlarge because of the pressure that builds up in the left atrium. Leading to lung congestion and shortness of breath, blood may back up into the lungs. The enlarged left atrium may also become prone to a heart rhythm irregularity called atrial fibrillation. The upper chambers (atria) of the heart beat chaotically and inefficiently in atrial fibrillation.

Mitral valve stenosis can weaken the heart and decrease how efficiently it pumps blood, just like other heart valve problems. The amount of blood that flows forward through the heart and out to the rest of the body is reduced by mitral valve stenosis.

The following are the complications that mitral valve stenosis can lead to when it is left unchecked:

Blood clots:
Atrial fibrillation can put the patient at risk of blood clots forming in the upper left chamber of the heart where blood pools in mitral valve stenosis in case this condition is left untreated. Causing serious problems, blood clots from the heart may break loose and travel to other parts of the body. For instance, a stroke may be caused by a blood clot that travels to the brain and blocks a blood vessel there. Whether blood clots have formed in a heart with a narrowed mitral valve may be determined by a transesophageal echocardiogram.

Heart enlargement:
Enlargement of the heart's upper left chamber (atrium) can be the result of the pressure buildup of mitral valve stenosis. Though this change helps the heart pump more efficiently at first, it eventually damages the heart's overall health. Moreover, pressure can build up in the lungs and cause pulmonary congestion and hypertension.

Lung congestion:
Pulmonary edema, a condition in which blood and fluid back up into the lungs, is another possible complication of mitral valve stenosis. Leading to shortness of breath and sometimes coughing up of blood-tinged sputum, this condition causes congestion of the lungs.

Heart failure:
The condition in which the heart is damaged and can't pump enough blood to meet the body's needs is called heart failure. Blood flow through the heart and from the heart out to the rest of the body is hindered by a narrowed mitral valve. Leading to fluid accumulation, pressure builds up in the lungs as well. This will eventually put a strain on the right side of the heart, leading to fluid buildup in the abdomen or ankles or both.

Atrial fibrillation:
The stretching and enlargement of the heart's left atrium may lead to a heart rhythm irregularity called atrial fibrillation in the case of mitral valve stenosis. The upper chambers of the heart beat chaotically and too quickly in atrial fibrillation.

Treatments:

Invasive procedures and medications are included in treatments to prevent permanent damage to the heart from mitral valve stenosis.

The patient doesn't always need invasive treatment right away for mitral valve stenosis. Generally, there's no need for immediate valve replacement or repair if tests reveal that the patient has mild to moderate mitral valve stenosis and he/she has no symptoms. To carefully monitor the valve so that surgery can be done as soon as the condition of the patient becomes severe, the doctor will schedule checkups. Some people never develop severe mitral valve stenosis, so they never need anything done to the mitral valve.

MEDICATIONS:
A defect in the mitral valve can be corrected by no medications. However by regulating the heart's rhythm and easing the heart's workload, certain drugs can reduce symptoms.

For instance, the following may be prescribed:

Blood thinners (anticoagulants):
To prevent blood clots from forming, these medications can help.

Antibiotics:  
To reduce the risk of bacteria entering the bloodstream of the patient and causing an infection in his/her heart (endocarditis), antibiotics may be recommended before certain dental or medical procedures.

Diuretics:
The fluid accumulation in the lungs or elsewhere can be reduced by these drugs.

To treat atrial fibrillation or other rhythm disturbances associated with mitral valve stenosis, drugs may be prescribed as well.

PROCEDURES:
Both surgical and nonsurgical options are available. To treat mitral valve stenosis, the patient may need valve replacement or repair.

Repair with balloon valvuloplasty (valvotomy):
A soft, thin tube (catheter) tipped with a balloon, is used in this nonsurgical procedure. A catheter is guided through a blood vessel in the groin or arm to the heart and into the narrowed mitral valve. A balloon at the tip of the catheter is inflated once it becomes in position. Improving blood flow, the balloon pushes open the mitral valve and stretches the valve opening. Then, the balloon is deflated and the catheter with balloon is guided back out of the body. Mitral valve stenosis and its symptoms can be relieved by balloon valvuloplasty. However, if the valve is both tight (stenotic) and leaky (regurgitant), this procedure may not be appropriate. Because of the risk of dislodging it, if there is a blood clot in a chamber of the heart, this procedure is not performed. Within 10 years, the patient may need the procedure repeated.

Mitral valve surgery:
Surgery may be a better option than balloon valvuloplasty if there is more than mild leakage (regurgitation) of the valve or if the patient has other valve problems in addition to mitral stenosis. The following are included in the surgical options:

Mitral valve replacement: Mitral valve replacement is the available procedure for most people with mitral valve stenosis who need surgery. The narrowed mitral valve is removed and replaced with a tissue valve or a mechanical valve. Tissue valves, which may come from a cow, human cadaver donor or pig, often need to be replaced. Mechanical valves that are made of metal, carry the risk of blood clots forming on or near the valve, despite the fact that they're durable. To prevent blood clots, the patient will need to take an anticoagulant medication such as warfarin (Coumadin), for life if he/she receives a mechanical mitral valve. The benefits and risks of each type of heart valve may be discussed with the doctor.
 
Valvuloplasty: A cardiac surgeon may make repairs such as removing obstructions on or near the mitral valve and separating fused valve leaflets using traditional surgical tools. This helps clear the valve passageway. If the patient develops mitral valve stenosis again in the years following surgery, he/she may need the procedure repeated.

Open-heart surgery may be involved in mitral valve surgery. However, techniques that use less invasive techniques are increasingly available. For instance, a surgeon watches a 3-D image of the area being operated on and uses hand controls that tell thin robotic arms how to maneuver surgical tools in robotic surgery. In most cases, recovery time in this approach that uses smaller incisions is faster.

Even after successful surgery for mitral valve stenosis, the patient may continue to be at risk of arrhythmias. To lower that risk, the patient may need to take medications.

OTHER PROCEDURES:
To try to keep the heart of the patient in normal rhythm, the surgeon may perform additional surgery at the time of the operation in some cases. Making a series of surgical incisions in the upper half of the heart (atria) is involved in this. These incisions heal into carefully placed scars in the atria that form boundaries that force electrical impulses in the heart to travel properly to cause the heart to beat efficiently.

Prognosis:

Not Available

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