I. Causes

  1. Rheumatic Fever
  2. Congenital Mitral Stenosis

II. Pathophysiology

  1. Increased left atrial pressure
    1. Pulmonary Vasoconstriction
    2. Pulmonary Hypertension
    3. Right Ventricular Failure
  2. Decreased Cardiac Output

III. Symptoms

  1. Symptoms of Left Ventricular Failure
    1. Dyspnea on exertion
    2. Orthopnea
    3. Paroxysmal Nocturnal Dyspnea
    4. Cough
  2. Symptoms of Right Ventricular Failure
  3. Other Symptoms
    1. Hemoptysis
  4. Precipitating Factors
    1. Exertion
    2. Fever
    3. Anemia
    4. Pregnancy
    5. Sexual intercourse
    6. Atrial Fibrillation

IV. Signs: Precordial Exam

  1. Diastolic Thrill
  2. Diastolic Murmur at apex
    1. Apical, low pitched rumbling in mid-diastole
    2. Loudest in early diastole
    3. Crescendo at end of diastole (presystolic)
    4. Accentuating factors
      1. Left lateral decubitus position
      2. Stethoscope bell
      3. Brief Exercise (e.g. brief walk in hallway)
  3. Opening snap of mitral valve cusp
    1. Heard at 3rd - 4th interspace at left sternal border
  4. Accentuated P2 heart sound
  5. Accentuated M1 heart sound
  6. Diminished M2 heart sound

V. Signs: Later findings of right ventricular failure

  1. Accentuated precordial thrust of right ventricle (lift)
  2. Elevated neck veins
  3. Ascites
  4. Edema

VI. Complications

  1. Hemoptysis
  2. Pulmonary Embolism
  3. Pulmonary infection
  4. Systemic emboli
  5. Endocarditis (uncommon)

VIII. Radiology

  1. Chest XRay
    1. Left atrial enlargement
    2. Right ventricular enlargement
    3. Posterior displacement of esophagus
    4. Mitral valve calcification
    5. Kerley B Lines
  2. Echocardiogram (Study of choice)
    1. Mitral valve leaflet changes
      1. Inadequate separation of valve leaflets
      2. Valve leaflet calcification and thickening
    2. Doppler estimates transvalvular gradient

IX. Course

  1. Slow, progressive, life-long course
  2. Latent period of 20 to 40 years after Rheumatic Fever
  3. Rapid acceleration of symptoms in later life

X. Management

  1. Rheumatic Fever prophylaxis until age 35 years
    1. Benzathine Penicillin G 1.2 MU IM qMonth OR
    2. Penicillin VK 125-250 mg PO bid
  2. SBE Prophylaxis
  3. Treat complications and associated conditions
    1. Atrial Fibrillation
    2. Congestive Heart Failure
    3. Anticoagulation for history of emboli
  4. Surgery
    1. Open Mitral valvuloplasty Indications
      1. Mitral orifice <= 1.2 cm2
      2. Cardiopulmonary symptoms
      3. Not a candidate for balloon valvotomy
    2. Percutaneous balloon valvuloplasty (Valvotomy)
      1. Indications
        1. NYHA Class II, III, IV moderate Mitral Stenosis
      2. Contraindications
        1. Non-pliable or calcified valve
        2. Subvalvular distortion
        3. No significant Mitral Regurgitation

Images: Related links to external sites (from Google)

Ontology: Mitral Valve Stenosis (C0026269)

Definition (NCI) Narrowing of the left atrioventricular mitral orifice.
Definition (CHV) narrowing of a heart valve
Definition (CHV) narrowing of a heart valve
Definition (CHV) narrowing of a heart valve
Definition (CSP) rheumatic disease causing diffuse thickening of the mitral valve leaflets by fibrous tissue or calcific deposits.
Definition (NCI) Narrowing of the left atrioventricular mitral orifice.
Definition (MSH) Narrowing of the passage through the MITRAL VALVE due to FIBROSIS, and CALCINOSIS in the leaflets and chordal areas. This elevates the left atrial pressure which, in turn, raises pulmonary venous and capillary pressure leading to bouts of DYSPNEA and TACHYCARDIA during physical exertion. RHEUMATIC FEVER is its primary cause.
Concepts Disease or Syndrome (T047)
MSH D008946
SnomedCT 79619009, 155277002, 194725005
English Mitral Valve Stenoses, Mitral Valve Stenosis, Stenoses, Mitral Valve, Valve Stenoses, Mitral, Valve Stenosis, Mitral, MITRAL VALVE, STENOSIS, MITRAL STENOSIS, MITRAL VALVE STENOSIS, Stenosis, Mitral Valve, mitral valve stenosis, Mitral valve stenosis, NOS, Mitral Stenoses, Mitral Stenosis, Stenoses, Mitral, Stenosis, Mitral, ms, mitral stenosis, mitral stenosis (diagnosis), STENOSIS, MITRAL, Mitral Valve Stenosis [Disease/Finding], MS, Mitral stenosis, MS - Mitral stenosis, Mitral valve stenosis, Mitral valve stenosis (disorder), mitral; stenosis, mitral; stricture, stenosis; mitral, stricture; mitral
Dutch mitralisstenose, mitraal; stenose, mitraal; strictuur, stenose; mitraal, strictuur; mitraal, mitralisklepstenose, Mitralisklepstenose, Mitralisstenose, Stenose, mitralisklep-
Spanish Estenosis mitral, Mitral stenosis, estenosis de la válvula mitral (trastorno), estenosis de la válvula mitral, estenosis mitral, Estenosis de la válvula mitral, Estenosis de la Válvula Mitral, Estenosis Mitral, Estenosis de la Valvula Mitral
Swedish Mitralklafförträngning
Japanese ソウボウベンキョウサクショウ, 僧帽弁狭窄症, 左房室弁狭窄症, 僧帽弁狭窄
Czech mitrální chlopeň - stenóza, Mitrální stenóza, Stenóza mitrální chlopně
Finnish Hiippaläpän ahtauma
French Sténose valvulaire mitrale, Rétrécissement valvulaire mitral, STENOSE MITRALE, Sténose de la valve mitrale, Rétrécissement mitral, Sténose mitrale, Rétrécissement de la valve mitrale
Russian MITRAL'NOGO KLAPANA STENOZ, МИТРАЛЬНОГО КЛАПАНА СТЕНОЗ
Portuguese ESTENOSE MITRAL, Estenose mitral, Estenose da Valva Mitral, Estenose Mitral
German MITRALSTENOSE, Mitralklappenstenose, Mitralstenose
Italian Stenosi della valvola mitralica, Stenosi della valvola mitrale, Stenosi mitralica
Croatian MITRALNA STENOZA
Polish Stenoza mitralna, Zwężenie mitralne, Zwężenie lewego ujścia żylnego, Zwężenie zastawki dwudzielnej
Hungarian Mitralis szűkület, Mitralis billentyű stenosis