Mitral Stenosis
Disease Description
Mitral stenosis is an acquired heart valve disease, meaning it develops over the course of a person’s life. In this condition, the anterior and posterior leaflets of the mitral (atrioventricular) valve, located between the left atrium and the left ventricle, become fused together.
In addition, the chordae tendineae and papillary muscles beneath the valve leaflets may also fuse with each other and with the valve leaflets. As a result, valve mobility during opening and closing is severely restricted, preventing normal blood flow through the valve. This leads to blood congestion in the pulmonary circulation.
Causes of the Disease
In the majority of cases, mitral stenosis has a rheumatic origin.
Rheumatic fever typically develops at a young age, while clinically significant mitral stenosis manifests 20–30 years later.
Other causes of mitral stenosis include infective endocarditis, cardiac trauma, syphilis, severe calcification of the mitral valve annulus and leaflets, atherosclerosis, left atrial myxoma, and congenital heart defects (such as Lutembacher syndrome).
Symptoms
The main symptom of mitral stenosis is shortness of breath, which may occur during physical exertion and eventually at rest due to blood congestion in the pulmonary vessels.
With long-standing mitral stenosis, patients may also develop a persistent cough, irregular heartbeats, and hemoptysis (coughing up blood).
If these symptoms occur, consultation with a cardiologist is essential.
Diagnosis
One of the most specific and widely used diagnostic methods for mitral stenosis is echocardiography. This ultrasound examination confirms the presence of mitral stenosis, determines its severity, and assesses the degree of pulmonary congestion (pulmonary hypertension).
Based on these findings, the physician can evaluate whether the patient is a candidate for surgical treatment.
Treatment
Treatment of mitral stenosis may follow two main approaches:
1. Conservative Treatment
A set of measures including lifestyle modification and medication therapy aimed at reducing symptoms and slowing disease progression.
2. Surgical Treatment
Surgical intervention is aimed at restoring normal blood flow through the narrowed atrioventricular orifice, thereby relieving the pulmonary circulation from excessive blood volume.
The procedure involves replacing the diseased, poorly functioning valve with either a mechanical or biological prosthetic valve.
Treatment Prognosis
Without treatment, the natural course of mitral stenosis may lead to severe disability. In advanced stages, mitral stenosis is often complicated by dangerous rhythm disturbances such as atrial fibrillation, or may result in fatal outcomes including pulmonary edema and death.
Ten-year survival among decompensated, untreated patients does not exceed 15%.
Once severe pulmonary hypertension develops, average life expectancy is reduced to approximately 3 years.