stenosis is a heart problem in which the
mitral valve doesn't open as wide as it should. The valve becomes stiff or scarred, or the valve flaps become partially joined
See a picture of
mitral valve stenosis.
Mitral valve stenosis can lead to
heart failure; a stroke; an infection in the heart (endocarditis);
or a fast, slow, or uneven heartbeat (arrhythmia). Fortunately, mitral valve stenosis can be treated.
Mitral valve stenosis is not common in
developed countries such as the United States, Canada, and western Europe.
Your heart has
four chambers and four valves. The valves have flaps, or leaflets. The flaps
open and close to keep blood flowing in the proper direction through your
The mitral valve connects the heart's upper left chamber
(left atrium) to the lower left chamber (left ventricle). When the heart pumps,
blood forces the flaps open, and blood flows from the left atrium to the left
ventricle. Between heartbeats, the flaps close tightly so that blood does not
leak backward through the valve.
With mitral valve stenosis, not as
much blood can flow into the left ventricle. More blood stays in the left
atrium, and blood may back up into the lungs.
See a picture of the
heart and its chambers, valves, and blood flow.
See a picture of a
normal mitral valve.
cases of mitral valve stenosis are caused by
rheumatic fever. This fever results from an untreated
strep infection, most often
strep throat. But many people who have mitral valve
stenosis don't realize that they had rheumatic fever.
don't develop until 10 to 20 years after stenosis starts, and they may take as long as
40 years to develop.
When symptoms first appear, they usually are mild. You may
only have a few symptoms, even if your mitral valve is very narrow. An early
symptom is shortness of breath when you are active. This shortness of breath
may seem normal to you.
Symptoms later in the disease may
Call your doctor if your symptoms get worse or you have
valve stenosis may not be diagnosed until you've had the disease for some time.
If you don't have symptoms, the first clue might be a heart murmur your doctor
hears during a routine checkup.
Your doctor will ask you questions
about your past health and do a physical exam. If your doctor thinks you might
have the disease, he or she may do more tests. These may include:
These tests also help your doctor find what caused the
stenosis and how severe it is.
Treatment depends on how severe
the disease and your symptoms are.
You will likely need regular echocardiograms so your
doctor can check for any changes in your mitral valve and heart.
If your stenosis is
mild, you'll probably be able to do your usual activities, get mild exercise,
and play some sports. But if your stenosis is moderate or severe, you may need to avoid intense exercise. But your doctor can help you choose an activity or exercise that is safe for you.
You may need to limit
sodium in your diet.
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Learning about mitral valve stenosis:
Living with mitral valve stenosis:
Nearly all cases of
mitral valve stenosis are caused by
rheumatic fever, which can follow an untreated
strep throat infection. But many people who have
mitral valve stenosis don't realize that they had rheumatic fever.
Other less common causes
mitral valve stenosis is a lifelong disease, symptoms
usually take 10 to 20 years to develop and can take as long as 40
you develop symptoms, they may not become severe for up to 10
Early symptoms are
often mild. In the later stages, the left atrium may become
damaged, causing more severe symptoms.
Symptoms of mitral valve stenosis include:
Other less common
You may not have any symptoms unless you exercise, are stressed, are pregnant, or have an infection or an irregular
heartbeat. Or you may have only a few symptoms, no matter how bad your stenosis is.
mitral valve stenosis are:
Marfan's syndrome can sometimes lead to stenosis. Any condition that
scars the valves, such as
endocarditis, also may cause stenosis.
Call 911 or other emergency services immediately if you have:
Call a doctor immediately if you
Health professionals who can evaluate symptoms and order further
tests as needed include:
cardiovascular surgeon may do surgical repair or replacement of
Mitral valve stenosis often has no symptoms in its early
stages. It may not be diagnosed until you've had the disease for some time. One or more
complications may lead to
The first sign of mitral valve stenosis could be a heart murmur that your doctor hears during a routine checkup.
A review of your
medical history and a physical exam can help your doctor find out if you have mitral valve
stenosis. Your doctor also can use them to plan your treatment.
Your doctor will ask about your
lifestyle, activity level, and family health history. Your doctor will want to know about your symptoms. He or she will ask if you have ever had:
physical exam, the doctor will:
echocardiogram is used to find out if you have mitral
valve stenosis and to see how bad it is. Your doctor can check your heart valve and take pictures of your heart.
In transesophageal echocardiography, a device is inserted down your throat and into
your esophagus to make pictures of your heart. This may be done if your doctor wants to see a different view of your heart.
You will likely have regular echocardiograms so your
doctor can keep track of any changes in your condition. Your doctor may recommend an echocardiogram every year if you have severe
stenosis, every 1 to 2 years if you have moderate stenosis, or every 3 to 5 years if you have mild stenosis.1
Electrocardiogram is used to measure the electrical
activity in the heart. Small metal discs called electrodes are attached to your
chest, arms, and legs. The electrodes are connected to a machine that
translates the electrical activity into line tracings on paper. Your doctor looks at the tracings to check for problems.
chest X-ray may show evidence of mitral valve
stenosis. The test may show enlargement of the upper left heart chamber (left atrium) or the
pulmonary arteries. Calcium deposits on the heart valves
sometimes may be seen, especially if the buildup is
Cardiac catheterization is usually done before any surgery for mitral valve
stenosis to evaluate your heart, the degree of stenosis, and the health of your coronary arteries. Knowing the condition of the
coronary arteries may affect later treatment decisions for stenosis.
mitral valve stenosis depends on how bad your
If you don't yet
have symptoms or you have mild, stable symptoms, your doctor may only
watch your condition with regular
echocardiograms. Your doctor will want you to call if you notice symptoms or if you have a change in symptoms you already have.
If you develop symptoms, your doctor may prescribe
medicine that lowers your blood pressure and reduces fluid buildup. For more information, see Medications.
stenosis gets worse, your doctor might suggest repairing or replacing your mitral valve.
Repairing the valve can be done by:
Mitral valve replacement surgery replaces the damaged valve with a new valve.
For more information, see Surgery.
Mitral valve stenosis can
be an easy condition to overlook in its mild form. But as it gets worse, it often
complications. These are serious problems that need treatment.
The most common complications are:
Other complications include:
information, see the topics Heart Failure,
Atrial Fibrillation, and
mitral valve stenosis can cause serious heart
damage. But you can help yourself live fully by working with your doctor and having a healthy lifestyle.
Talk to your doctor about how often you
need to be examined. You will likely have regular echocardiograms so your
doctor can keep track of any changes in your condition. How often you get the test depends on how bad your stenosis is.
Call your doctor if your symptoms get worse or you have new symptoms. For more information, see When to Call a Doctor.
Ask your doctor what level of exercise is safe for you. Exercise helps keep your heart and body healthy. But when you have mitral valve stenosis, exercise can put extra strain on your heart and cause symptoms like fluid buildup in your lungs. So exercise with care and be aware of any symptoms like shortness of breath. If you
don't exercise, talk to your doctor before you start.
If your stenosis is mild and you don't have symptoms, your doctor may encourage you to do low-level aerobic exercise.
If your stenosis is moderate or severe
and you have symptoms, you should avoid strenuous activity. You may be able to
do low-level activities to help keep your heart healthy.
People who have severe
stenosis may need to be cautious about their level of physical activity. You may be able to do
certain types of exercise that won't strain your heart.
Depending on how bad your symptoms are, your doctor may advise you to limit sodium. If you consume too much
sodium, it will cause your body to retain excess
fluid. Excess fluid in the body will cause swelling, trouble breathing,
fatigue, and other side effects.
Cutting back on sodium usually includes avoiding foods such as potato chips, pretzels, processed meats
and cheeses, canned soups, and fast foods.
When you shop for groceries, check labels carefully for
Medicines are often used to relieve the
symptoms and prevent complications of
mitral valve stenosis. Usually they are also
prescribed after surgery to repair or replace the valve.
Diuretics ("water pills") reduce fluid buildup and
related swelling. They may also lower blood pressure in the upper left heart
chamber (left atrium) and relieve breathing problems.
Medicines used to treat complications
You may need surgery to repair or
replace your mitral valve if medicines don't
control your symptoms or if your doctor thinks that you need more treatment.
Deciding whether you need
surgery and if so, when, depends on the
severity of your disease, the possibility that it will get worse,
and the risks of surgery.
For more information about the decision to repair or replace a mitral valve, see Mitral Valve Stenosis: Repair or Replace the Valve?
You may have one of the following procedures to repair the valve:
Mitral valve replacement surgery might be done if the valve is damaged beyond repair. This surgery is typically an open-heart surgery using a heart-lung bypass machine.
If you have valve replacement surgery, a mechanical or tissue valve will be used to replace your heart valve. Before you have surgery, you and your doctor will decide which type of valve is right for you. To help with this decision, see:
The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the website describes diseases, surgeries, patient options, and what to expect after surgery. And using the website, you can search for surgeons in your area.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
CitationsBonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):Other Works ConsultedBonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):Carabello BA (2011). Mitral stenosis. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1738–1744. New York: McGraw-Hill.Oakley RE, et al. (2008). Choice of prosthetic heart valve in today's practice. Circulation, 117(2): 253–256.Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.Rodriguez L, Gillinov AM (2007). Mitral valve disease. In EJ Topol, ed., Textbook of Cardiovascular Medicine. Philadelphia: Lippincott Williams and Wilkins.
November 18, 2011
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & John A. McPherson, MD, FACC, FSCAI - Cardiology
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