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| __NOTOC__
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| {{Mitral stenosis}}
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| {{CMG}} {{AE}} {{RT}}
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| ==Overview==
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| [[Mitral stenosis]] is a valvular disease characterized by a narrowing in the heart valve between the two left chambers of the heart ([[left atrium]] and [[left ventricle]]).
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| ==Pathophysiology==
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| * Commisural fusion is the hallmark anatomic finding in mitral stenosis.
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| * The narrowing in the [[mitral valve]] causes build up of pressures in the left atrium, and eventually in the pulmonary bed.
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| * The build up of pressures in the pulmonary bed leads to [[pulmonary hypertension]] which results in [[right heart failure]].
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| * The left ventricle is unaffected in pure mitral stenosis.
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| ==Causes==
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| The cause of [[mitral stenosis]] is almost always [[rheumatic heart disease]].
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| ==Differentiating Mitral stenosis from other Diseases==
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| Mitral stenosis should be differentiated from:
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| * [[Cor triatriatum]]
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| * [[Atrial myxoma]]
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| * Pulmonary vein obstruction
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| ==Natural History and Complications==
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| ===Natural History===
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| Mitral stenosis is intermittently progressive and has a prolonged clinical course before becoming severe.
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| ===Complications===
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| Complications occur in the late stages of mitral stenosis. They include:
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| * [[Atrial fibrillation]]
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| * [[Pulmonary hypertension]]
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| * [[Right heart failure]]
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| * [[Stroke]] - due to thrombus formation in the [[left atrium]]
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| ==Diagnosis==
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| ===Symptoms===
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| Symptoms of mitral stenosis occur late in the course of the disease as the disease progresses slowly over decades. Common symptoms include:
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| * [[Dyspnea]]
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| * [[Paroxysmal nocturnal dyspnea]]
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| * [[Orthopnea]]
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| * [[Hemoptysis]]
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| * [[Palpitations]]
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| * [[Emboli]]
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| ===Physical Examination===
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| * A high pitched additional sound called opening snap (OS) may be heard after the A<sub>2</sub> component of S<sub>2</sub> and it signifies the forceful opening of the mitral valve.
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| * The S<sub>2</sub> - OS interval determines the severity of mitral stenosis.
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| ** Mild: >110 msec
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| ** Moderate: 70-110 msec
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| ** Severe: <70 msec
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| The closer the gap between S<sub>2</sub> and OS the severe the stenosis is.
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| ===Imaging===
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| ====Echocardiography====
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| * ECHO is the gold standard for diagnosis and quantification of [[mitral stenosis]]. It is a better diagnostic tool than cardiac catheterization.
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| * To define the anatomy of the stenotic lesion a 2D echocardiography is used and to define the hemodynamics of blood flow through the stenotic valve a Doppler ECHO is preferred.
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| ** Doppler is the gold standard for quantifying the transmitral pressure gradient.
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| ==Treatment==
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| * General principles in the management of mitral stenosis include:
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| ** [[Anticoagulation]] - if [[atrial fibrillation]] is present
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| ** For class I and II symptoms observing is the preferred treatment.
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| ** Replacement of mitral valve - if class III and IV symptoms.
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| ===Percutaneous mitral balloon valvotomy===
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| ====Indications====
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| * Class II, III and IV symptoms
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| * Asymptomatic patients with:
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| ** Pulmonary artery pressure >60mm Hg
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| ** New onset [[atrial fibrillation]]
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| ====Contraindications====
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| * Mitral regurgitation +2
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| * Left atrium [[thrombus]]
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| * Severe calcifications of the mitral valve
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| Results of the procedure are excellent with pliable valves, fused commissures and with no calcium deposits on the valve. Survival rates are lower with calcified commissures than with non-calcified commissures.
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| ==References==
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| {{Reflist|2}}
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| [[Category:Valvular heart disease]]
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| [[Category:Cardiology]]
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| [[Category:Cardiac surgery]]
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| [[Category:Surgery]]
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| [[Category:Overview complete]]
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| [[Category:For review]]
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| [[Category:Template complete]]
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| {{WH}}
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| {{WS}}
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