Mitral stenosis natural history, complications and prognosis: Difference between revisions

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==Prognosis==
==Prognosis==
===Asymptomatic Patients===
===Asymptomatic Patients===
Survival is >80% at 10 years.<ref name="pmid13199730">{{cite journal| author=WILSON JK, GREENWOOD WF| title=The natural history of mitral stenosis. | journal=Can Med Assoc J | year= 1954 | volume= 71 | issue= 4 | pages= 323-31 | pmid=13199730 | doi= | pmc=1824874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13199730  }} </ref><ref name="pmid12208789">{{cite journal| author=Rahimtoola SH, Durairaj A, Mehra A, Nuno I| title=Current evaluation and management of patients with mitral stenosis. | journal=Circulation | year= 2002 | volume= 106 | issue= 10 | pages= 1183-8 | pmid=12208789 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12208789  }} </ref>
Survival is >80% at 10 years.<ref name="pmid13199730">{{cite journal| author=WILSON JK, GREENWOOD WF| title=The natural history of mitral stenosis. | journal=Can Med Assoc J | year= 1954 | volume= 71 | issue= 4 | pages= 323-31 | pmid=13199730 | doi= | pmc=1824874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13199730  }} </ref><ref name="pmid12208789">{{cite journal| author=Rahimtoola SH, Durairaj A, Mehra A, Nuno I| title=Current evaluation and management of patients with mitral stenosis. | journal=Circulation | year= 2002 | volume= 106 | issue= 10 | pages= 1183-8 | pmid=12208789 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12208789  }} </ref>       Provider: John Wiley & Sons, Ltd
Content:text/plain; charset="UTF-8"
 
TY  - JOUR
TI  - THE PROGNOSIS OF MITRAL STENOSIS
JO  - Acta Medica Scandinavica
VL  - 169
IS  - S362
PB  - Blackwell Publishing Ltd
SN  - 0954-6820
UR  - http://dx.doi.org/10.1111/j.0954-6820.1961.tb07083.x
DO  - 10.1111/j.0954-6820.1961.tb07083.x
SP  - 109
EP  - 114
PY  - 1961
ER  -
                                       
 


===Symptomatic Patients Without Treatment===
===Symptomatic Patients Without Treatment===

Revision as of 19:33, 7 December 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

After the initial episode of rheumatic fever, there is a latent period of 20 years before the onset of symptoms in mitral stenosis. Complications of mitral stenosis are left and right heart failure, endocarditis and embolization (stroke) and pulmonary embolism. Survival in asymptomatic patients is 80% at 10 years. Once symptoms develop, if mitral stenosis is left untreated, survival at 10 years is only 15%. The majority of patients die due to complications of pulmonary hypertension (which is associated with a mean survival of 3 years after its onset) and right heart failure.

Natural History

The natural history of mitral stenosis secondary to rheumatic fever (the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever. This latent period lasts an average of 16.3 ± 5.2 years. Once symptoms of mitral stenosis begin to develop, progression to severe disability takes 9.2 ± 4.3 years. In some areas of the developing world, the rate of progression is more rapid due to repeated infections, poorer treatment of the infections, or more virulent infections and the patient may be symptomatic as early as the late teens.

Death from mitral stenosis is due to the progressive increase in pulmonary capillary wedge pressure, pulmonary hypertension, and subsequent right-sided heart failure. This is the cause of death in 60 percent of mitral stenosis cases that are not treated.[1][2]

Other less frequent causes of death include:[3]

Complications

Complications of mitral stenosis are left and right heart failure, endocarditis, and embolization.[4]

Shown below is a list of the manifestations of the complications of mitral stenosis:

Prognosis

Asymptomatic Patients

Survival is >80% at 10 years.[5][6] Provider: John Wiley & Sons, Ltd Content:text/plain; charset="UTF-8"

TY - JOUR TI - THE PROGNOSIS OF MITRAL STENOSIS JO - Acta Medica Scandinavica VL - 169 IS - S362 PB - Blackwell Publishing Ltd SN - 0954-6820 UR - http://dx.doi.org/10.1111/j.0954-6820.1961.tb07083.x DO - 10.1111/j.0954-6820.1961.tb07083.x SP - 109 EP - 114 PY - 1961 ER -


Symptomatic Patients Without Treatment

In individuals who were offered mitral valve surgery but refused, survival with medical therapy alone was 44 ± 6 % at 5 years, and 32 ± 8 % at 10 years after they were offered correction.[7]

Presence of Pulmonary Hypertension

In the presence of pulmonary hypertension, the mean survival is less than 3 years.

References

  1. 1.0 1.1 ROWE JC, BLAND EF, SPRAGUE HB, WHITE PD (1960). "The course of mitral stenosis without surgery: ten- and twenty-year perspectives". Ann Intern Med. 52: 741–9. PMID 14439687.
  2. OLESEN KH (1962). "The natural history of 271 patients with mitral stenosis under medical treatment". Br Heart J. 24: 349–57. PMC 1017892. PMID 14481743.
  3. Abernathy WS, Willis PW (1973). "Thromboembolic complications of rheumatic heart disease". Cardiovasc Clin. 5 (2): 131–75. PMID 4780192.
  4. 4.0 4.1 Selzer A, Cohn KE (1972). "Natural history of mitral stenosis: a review". Circulation. 45 (4): 878–90. PMID 4552598.
  5. WILSON JK, GREENWOOD WF (1954). "The natural history of mitral stenosis". Can Med Assoc J. 71 (4): 323–31. PMC 1824874. PMID 13199730.
  6. Rahimtoola SH, Durairaj A, Mehra A, Nuno I (2002). "Current evaluation and management of patients with mitral stenosis". Circulation. 106 (10): 1183–8. PMID 12208789.
  7. Carabello BA (2005). "Modern management of mitral stenosis". Circulation. 112 (3): 432–7. doi:10.1161/CIRCULATIONAHA.104.532498. PMID 16027271.

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