Mitral Valve Stenosis
The term stenosis means an abnormal narrowing of an opening. Mitral valve stenosis refers to a condition in the heart in which one of the valve openings has become narrow and restricts the flow of blood from the upper left chamber (left atrium) to the lower left chamber (left ventricle).
In the heart, the valve that regulates the flow of blood between the left atrium and the left ventricle is called the mitral valve. If the mitral valve is abnormally narrow, due to disease or birth defect, blood flow from the atrium to the ventricle is restricted. This restricted flow leads to an increase in the pressure of blood in the left atrium. Over a period of time, this back pressure causes fluid to leak into the lungs. It can also lead to an abnormal heart rhythm (atrial fibrillation), which further decreases the efficiency of the pumping action of the heart.
Causes and symptoms
Mitral valve stenosis is almost always caused by rheumatic fever. As a result of rheumatic fever, the leaflets that form the opening of the valve are partially fused together. Mitral valve stenosis can also be present at birth. Babies born with this problem usually require surgery if they are to survive. Sometimes, growths or tumors can block the mitral valve, mimicking mitral valve stenosis.
If the restriction is severe, the increased blood pressure can lead to heart failure. The first symptoms of heart failure, which are fatigue and shortness of breath, usually appear only during physical activity. As the condition gets worse, symptoms may also be felt even during rest. A person may also develop a deep red coloring in the cheeks.
Mitral valve stenosis is usually detected by a physician listening to heart sounds. Normal heart valves open silently to permit the flow of blood. A stenotic valve makes a snapping sound followed by a "rumbling" murmur. The condition can be confirmed with a chest x ray and an electrocardiogram, both of which will show an enlarged atrium. Echocardiography, which produces images of the heart's structure, is also helpful in making the diagnosis. If surgery is necessary, cardiac catheterization may be done to fully evaluate the heart before the operation.
Drug therapy may help to slow the heart rate, strengthen the heart beat, and control abnormal heart rhythm. Drugs such as beta blockers, calcium channel blockers, and digoxin may be prescribed. A drug that prevents abnormal blood clotting (anticoagulant) called warfarin (Coumadin) may be recommended. If drug therapy does not produce satisfactory results, valve repair or replacement may be necessary.
Repair can be accomplished in two ways. In the first method, balloon valvuloplasty, the doctor will try to stretch the valve opening by threading a thin tube (catheter) with a balloon tip through a vein and into the heart. Once the catheter is positioned in the valve, the balloon is inflated, separating the fused areas. The second method involves opening the heart and surgically separating the fused areas.
If the valve is damaged beyond repair, it can be replaced with a mechanical valve or one that is partly mechanical and partly made from a pig's heart.
Procedures available to treat mitral valve stenosis, whether medical or surgical, all produce effective results.
The only possible way to prevent mitral valve stenosis is to prevent rheumatic fever. This can be done by evaluating sore throats for the presence of the bacteria that causes strep throat. Strep throat is easily treated with antibiotics.
McGoon, Michael D., ed. Mayo Clinic Heart Book: The Ultimate Guide to Heart Health. New York: William Morrow and Co., Inc., 1993.
"Opening Mitral Valves Without Surgery." Harvard Heart Letter 6 (Nov. 1995): 5+.
American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. <http://www.americanheart.org>.
The Merck Page. <http://www.merck.com>.
Dorothy Elinor Stonely
Atrium—One of the two upper chambers of the heart.
Beta blocker—A drug that can be used to reduce blood pressure.
Rheumatic fever—An illness which sometimes follows a streptococcal infection of the throat.
Ventricle—One of the two lower chambers of the heart.