Mitral Valve Stenosis
Mitral valve stenosis is an acquired heart defect, which cause mitral valve narrowing. Mitral valve stenosis treatment works well and can be conservative (drugs and medications) as well as surgical (balloon valvuloplasty or mitral valve replacement). We will discuss symptoms, diagnostic methods and mitral valve stenosis treatment options in more details below.
What is Mitral Valve Stenosis?
Mitral valve stenosis, also known as mitral stenosis, is when the mitral valve opening is stiff and narrow. This causes insufficient amounts of blood to flow through it. This can lead to a variety of issues, including fatigue, blood clots, difficulty breathing and even heart failure.
The mitral valve is located on the left side of your heart, between two chambers: the atrium (upper) and the ventricle (lower). Blood is pumped from the left atrium, through the mitral valve, and into the left ventricle on its way to the aorta. A normal, healthy mitral valve allows blood to pass through, but prevents it from flowing backwards.
Mitral valve stenosis is most often caused by rheumatic fever. This is usually a disease that occurs during childhood and is a result of the body’s immune response to an infection with the streptococcal bacteria. It is a serious complication of strep throat or scarlet fever.
The body’s organs most affected by the acute rheumatic fever are the heart and joints. The lining of the heart (endocarditis), the heart muscle (myocarditis), and the membrane surrounding the heart (pericarditis) can become inflamed. The joints can become very inflamed and can lead to temporary and sometimes chronic disability.
When the mitral valve (or any of the heart valves) becomes affected, this causes a chronic heart condition called rheumatic heart disease. The clinical signs and symptoms of this condition may not occur until 5 to 10 years after the rheumatic fever occurs.
SYMPTOMS OF MITRAL VALVE STENOSIS
You may feel fine with mitral valve stenosis, or you may have minor symptoms for years or even decades. However, mild problems can, in some cases, worsen very quickly. It is essential you see your doctor if you develop:
- Shortness of breath, especially with exertion or when you lie down
- Fatigue, especially during increased physical activity
- Swollen legs or feet
- Heart palpitations — sensations of a rapid, fluttering heartbeat
- Dizziness or fainting
- Heavy coughing, sometimes with blood-tinged sputum
- Chest discomfort or chest pain
- Severe headache, trouble speaking or other symptoms of a stroke
Mitral valve stenosis symptoms may appear or worsen anytime your heart rate increases, such as during exercise. An episode of rapid heartbeats may accompany these symptoms. They may also be triggered by pregnancy or other stresses on the body, such as an infection.
In mitral valve stenosis, pressure builds up in the heart and is then sent back to the lungs, resulting in fluid build-up (congestion) and shortness of breath.
Symptoms of mitral valve stenosis most often appear in people between the ages of 30 and 50 in developed nations, however, they can occur at any age (including childhood).
Mitral valve stenosis may also produce signs that your doctor will find during your examination. These may include:
- Heart murmurs
- Fluid build-up in your lungs
- Irregular heart rhythms (arrhythmias)
MITRAL VALVE STENOSIS TREATMENT OPTIONS
Treatment for mitral valve stenosis depends largely on your symptoms and the severity of the condition. If you have no symptoms and only mild mitral valve stenosis, you might not require treatment at all.
Drugs and Medication
If your mitral valve stenosis is causing symptoms, your doctor might prescribe medications Including:
- anticoagulants (blood thinners)
- diuretics (to reduce fluid build-up through increased urine output)
- antiarrhythmics (medications to treat abnormal heart rhythms)
- beta-blockers (medications to slow your heart rate)
Although these do not actually fix the problem with your mitral valve, they can help treat your symptoms.
You may need valve repair or replacement to treat mitral valve stenosis. There are surgical and nonsurgical options available.
Repair with balloon valvuloplasty
This is a nonsurgical procedure that uses a soft, thin tube (catheter) tipped with a balloon. A doctor guides the catheter through a blood vessel in your arm or groin to the affected valve. Once in position, the balloon is then inflated to widen the narrow valve, immediately improving blood flow. The balloon is then deflated and removed along with the catheter.
For some people, balloon valvuloplasty relieves the signs and symptoms of mitral valve stenosis as effectively as surgery. However, if your condition worsens over time, you may need the procedure repeated.
Not everyone with mitral valve stenosis is a candidate for balloon valvuloplasty. It is important that you talk to your doctor to decide whether it’s a suitable option for you.
Mitral Valve Surgery
Surgical options for Mitral Valve Stenosis include:
- Commissurotomy: If balloon valvuloplasty isn’t an option, a cardiac surgeon may perform open-heart surgery to remove calcium deposits and other scar tissue to clear the valve passageway. An open commissurotomy requires that you be put on a heart-lung bypass machine during the surgery. You may need the procedure repeated if your mitral valve stenosis comes back.
- Mitral valve replacement: Your surgeon removes the narrowed valve and replaces it with a mechanical or tissue valve. Mechanical valves, made from metal, are durable but carry the risk of blood clots forming. If you receive a mechanical mitral valve, you’ll need to take an anticoagulant medication, such as warfarin (Coumadin), for the rest of your life in order to prevent blood clots from forming. If blood clots form they can travel to your brain, causing a stroke. Tissue valves — which may come from a pig, cow or human deceased donor —will in many cases, need to be replaced over time. Your doctor will inform you of the risks and benefits of each type of heart valve with you.
DIAGNOSING MITRAL VALVE STENOSIS
- History taking & Physical examination: During a physical examination, your doctor will ask about your medical history and give you a physical examination that includes having a listen to your heart using a stethoscope. A sure sign of mitral valve stenosis is an abnormal heart sound, called a heart murmur.Your doctor also will listen to your lungs to check lung congestion — a build-up of fluid in your lungs — that can occur with mitral valve stenosis.
- Transthoracic echocardiogram: Sound waves directed at your heart using a wand-like device (transducer) held on your chest produce video images of your heart in motion. This test confirms the diagnosis of mitral stenosis.
- Electrocardiogram (ECG): Wires (electrodes) attached to pads on your skin measure electrical impulses from your heart, providing information about your hearts’ rhythm. You may be asked to walk on a treadmill or pedal a stationary bike during an ECG to see how your heart responds to increased exertion.
- Chest X-ray: This test allows your doctor to determine whether any chamber of the heart is enlarged and the condition of your lungs.
- Transesophageal echocardiogram: A small transducer attached to the end of a tube is inserted down your oesophagus allowing for a closer look at the mitral valve.
- Cardiac catheterization: This invasive technique isn’t performed routinely for mitral stenosis, but it might be required when more information is needed to assess your condition. It involves threading a thin tube (catheter) through a blood vessel in your arm or groin to an artery located in your heart. A dye is then injected through the catheter to make the artery visible on an X-ray. This provides a more detailed picture of your heart. Cardiac tests such as these help your doctor distinguish mitral valve stenosis from other heart conditions, including other mitral valve conditions such as Mitral Valve Prolapse. These tests also help reveal the cause of your mitral valve stenosis and whether the valve can be repaired or not.
