Mitral stenosis natural history, complications and prognosis

Revision as of 21:09, 1 February 2013 by Charmaine Patel (talk | contribs)
Jump to navigation Jump to search

Mitral Stenosis Microchapters

Home

Patient Information

Overview

Pathophysiology

Causes

Differentiating Mitral Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Stages

History and Symptoms

Physical Examination

Electrocardiogram

Chest X Ray

Echocardiography

Cardiac MRI

Cardiac Catheterization

Treatment

Overview

Medical Therapy

Percutaneous Mitral Balloon Commissurotomy (PMBC)

Surgery

Follow Up

Prevention

Case Studies

Case #1

Mitral stenosis natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Mitral stenosis natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onMitral stenosis natural history, complications and prognosis

CDC on Mitral stenosis natural history, complications and prognosis

Mitral stenosis natural history, complications and prognosis in the news

Blogs on Mitral stenosis natural history, complications and prognosis

Directions to Hospitals Treating Mitral Stenosis

Risk calculators and risk factors for Mitral stenosis natural history, complications and prognosis

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 mode 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]

Prognosis

Asymptomatic Patients

Survival is >80% at 10 years

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.

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.

Template:WH Template:WS