Table of Contents
- What is mitral valve stenosis?
- Who is affected by mitral valve stenosis?
- What are the causes of mitral valve stenosis?
- What are the symptoms of mitral valve stenosis?
- How is mitral valve stenosis diagnosed?
- Can mitral valve stenosis be cured?
- Will someone with mitral stenosis have problems during pregnancy?
- How is mitral valve stenosis treated?
- References
What is mitral valve stenosis?
Heart valves are a kind of door that allows blood to pass in one direction. The mitral valve is one of the four valves of the heart. Mitral valve stenosis is a narrowing of the valve that controls blood flow between the left atrium and ventricle of the heart. Mitral valve stenosis is also called mitral stenosis (mitral stenosis; MS). Mitral stenosis prevents blood from flowing freely from the left atrium to the left ventricle. Over time, this can lead to a disturbed heart rhythm, heart failure, stroke due to a blood clot and death.
Who is affected by mitral valve stenosis?
Mitral valve stenosis is much more common in women than in men. In developed countries, mitral valve stenosis often occurs at an older age (50s and 60s). In economically weaker countries, it occurs at a younger age.
What are the causes of mitral valve stenosis?
- Rheumatic fever It is the most common cause. This condition is also called rheumatic mitral stenosis. It is popularly known as "throat infection hitting the heart". In childhood tonsillitis or pharyngitis caused by bacteria (not viruses), the immune system cells are activated and want to destroy the bacteria. However, the same protein found in bacteria is also found in the structure of some people's heart valves. The defense cells cannot distinguish this protein from the bacterial protein and, in attacking them, mistakenly attack the heart valve tissue. The valve tissue inflamed by the attack begins to heal, but within months/years its structure deteriorates and hardens. Stenosis and sometimes leakage develops in the valve with impaired elasticity. This whole process can take many years and the patient may feel the first complaints years later.
- Age-related arthritis: This type of stenosis is caused by calcium deposits in the valve. This type of stenosis is very difficult to treat, even with surgery. Fortunately, in most people it causes only mild or moderate stenosis and often does not require treatment.
- Congenital (Congenital): It is usually recognized in infancy.
- Radiation therapy: Radiation therapy for some types of cancer in the chest can also disrupt the mitral valve and cause it to thicken and harden. Typically, it manifests itself 20 to 30 years after radiation treatment.
What are the symptoms of mitral valve stenosis?
- Rapid fatigue and shortness of breath: They are the most common symptoms. It usually occurs when doing work or going uphill. In severe stenosis, shortness of breath may occur even at rest.
- Palpitations With less blood passing through the narrow space, the heart has to work faster to send the same amount of blood to the body. This can cause palpitations in the patient.
- Stroke (Paralysis): Because of the stenosis, the pressure in the left atrium of the heart increases, the atrium enlarges and sometimes atrial fibrillation (AF) a rhythm disorder called arrhythmia. This can lead to the formation of a clot in the heart, which can break away from the heart and travel through the bloodstream to the brain and cause a stroke.
- Coughing up blood from the mouth: Increased pressure in the left atrium of the heart is also reflected in the pulmonary veins and can cause coughing up blood.
- Swelling in the abdomen or legs (edema)
How is mitral valve stenosis diagnosed?
- ECHO (Echocardiography; heart ultrasound): It is the most important diagnostic test. It uses sound waves to obtain images of the heart and can easily determine whether the valve is stenotic or not. Sometimes an ECHO through the esophagus (transesophageal echocardiography; TEE) may be needed to obtain a clearer image.
- ECG (Electrocardiography): ECG measures the electrical activity of the heart. It is used to detect rhythm disturbances due to mitral stenosis. Electrical changes due to enlargement of the left atrium can also be detected.
- Chest X-ray It shows the condition of the heart and lungs. You may notice that the atria are enlarged.
- CT (Computed tomography)
- MRI (Magnetic resonance imaging; MRI)
- Cardiac catheterization
Can mitral valve stenosis be cured?
Mitral valve stenosis does not get better on its own; in fact, it is a disease that progresses over time.
Will someone with mitral stenosis have problems during pregnancy?
If a woman with mitral valve stenosis wants to become pregnant, she should first consult her doctor and be informed about the risks. This is because pregnancy causes the heart to work harder. How the heart with mitral valve stenosis can handle the additional load depends on the severity of the valve stenosis and the pumping power of the heart. In patients with critical valve stenosis, pregnancy can be very troublesome and may pose a life-threatening risk for both mother and baby.
How is mitral valve stenosis treated?
What is mitral balloon therapy?
A balloon is sent to the heart through a vein in the groin. The balloon is aligned exactly where the stenosis is and inflated. The inflated balloon ruptures the adhesions causing the stenosis and enlarges the valve area. As blood flow increases, the patient's symptoms improve. This method does not require cutting the rib cage or stopping the heart. However, it is not suitable for everyone. In this case, surgery is often required. Valve replacement (insertion of an artificial valve) is the preferred method rather than repair.
Prof. Dr. Şükrü Akyüz is an interventional cardiologist. His specialty is the treatment of heart diseases with non-surgical methods, including mitral balloon procedure.
How long does it take to recover after surgery or non-surgical treatment?
Full recovery after surgery takes several weeks. With the non-surgical method, most patients are discharged the next day and recovery is faster than with surgery. In some cases where treatment is delayed, the increased pressure in the pulmonary artery (pulmonary hypertension) may have become permanent and full recovery may not be possible.
References
- Otto CM, Nishimura RA, Bonow RO, et al. ACC/AHA Guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2021 Feb 2;77(4):e25-e197.
- Vahanian A, Beyersdorf F, Praz F, et al. ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632.
- Libby P, Bonow RO, and Mann DL, eds. Braunwald's heart disease: A textbook of cardiovascular medicine, 12th ed. Philadelphia PA: Elsevier; 2022.