A stenosed mitral valve is an acquired heart defect that can contribute to heart failure and embolism, and ultimately lead to death. It is a chronic, progressive disease, so when the first symptoms appear, immediate diagnosis is required. What are the causes and symptoms of a narrowed mitral heart valve? How is this type of heart defect treated?

Mitral valve stenosis(aka mitral stenosis or stenosis of the left venous outlet) isacquired heart defect , which consists of more than a double reduction valve surface. As a consequence, blood flow from the left atrium to the left ventricle is obstructed.

Contents:

  1. Mitral stenosis - causes
  2. Mitral valve stenosis - symptoms
  3. Mitral stenosis - diagnosis
  4. Mitral stenosis - treatment

Mitral stenosis - causes

Stricture of the left venous outletusually results from complications after an infectious disease, usually caused by streptococci. A complication after pharyngitis or purulent angina may berheumatic fever- the world's most common cause of acquired heart defects in children and young people.

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In the course of this disease, inflammatory changes occur in the connective tissue of the heart and vessels, where the valve leaflets are thickened and fused, as well as in the ligaments and tendon cords. The progressive process of scarring of these structures limits the mobility of the valve leaflets and reduces the lumen of the orifice. Incorrect blood flow through the changed valve further intensifies the thickening processes of all structures related to the valve. Progressive narrowing of the mitral valve leads to an enlargement of the left atrium, fibrosis of its wall and an increase in pressure in the left atrium, which is transferred to the vessels in the lungs. With advanced lesions, pulmonary edema (as a result of increased pressure in the veins and pulmonary capillaries and the expansion of these vessels) and slow development of pulmonary hypertension may occur. Consequently, maybethere are embolisms caused by the displacement of blood clots from the left atrium to other organs (e.g. stroke)

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Other infectious diseases that may cause stenosis of the mitral valve:

  • infective endocarditis and calcification of the mitral ring
  • systemic lupus erythematosus
  • rheumatoid arthritis
  • mucopolysaccharidosis (metabolic disease)
  • congenital deformity of the mitral valve

Less frequent causes of stenosis are storage diseases and left atrial myxoma.

Mitral valve stenosis - symptoms

  • getting tired quickly
  • limiting exercise tolerance
  • exercise-induced dyspnoea
  • recurrent respiratory infections
  • palpitations
  • cough with expectoration of foamy, blood-colored discharge.

Symptoms usually appear 15-20 years after having rheumatic fever.

Mitral stenosis - diagnosis

The doctor, while auscultating the heart, may hear a characteristic loud crackle that arises when the mitral valve is opened, followed by a diastolic murmur of blood flow through the narrowed valve opening. During the examination, the doctor may also measure the heart rate, which with this heart defect should be weakly tense and poorly filled. However, the physical examination itself may only suggest a defect. The main method of diagnosing military valve stenosis is still echocardiography, thanks to which it is possible to measure the area of ​​the orifice and the speed of blood flow through the narrowed outlet. On this basis, the severity of the defect can be assessed.

The following tests are also required: an ECG showing left atrial enlargement, atrial rhythm disturbances, and an X-ray showing an enlarged left atrium or dilatation of the pulmonary artery.

As an alternative, a coronary angiography (to exclude ischemic heart disease) and an exercise test to assess physical capacity can be performed.

Mitral stenosis - treatment

1. Conservative treatment

Patients with mild mitral stenosis and normal heart function do not require pharmacological treatment based on diuretics, digoxin and angiotensin converting enzyme inhibitors. However, prevention of cardiac arrhythmias is necessary, as patients with mitral stenosis tend to suffer from arrhythmias.

If one of the complications of the defect is flickeringatria, anticoagulant therapy is used to prevent blockage formation. Remember that the risk of embolism increases with age and the occurrence of AF.

The prevention of infective endocarditis and relapses of rheumatic fever is also important.

2. Semi-invasive therapy and invasive treatment

If possible, semi-invasive therapy is used. A balloon mitral valvulotomy is then performed. The procedure involves unsticking or tearing the fused mitral valve petals with a catheter with a balloon inserted through the skin. Valvulotomy is a relatively safe procedure and its effectiveness is approx. 95%. In rare cases, mitral regurgitation may develop after valvulotomy.

Contraindications for mitral valvulotomy are the risk of embolism or calcification of the subvalvular apparatus. Surgical treatment is then performed.

If the defect needs to be completely corrected, surgery is performed to repair or replace the mitral valve. In the latter case, a mechanical or biological prosthesis is implanted in place of the removed, diseased valve.

Category:

Cardiology