Mitral Stenosis Treatment and Surgery

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Vejthani

Overview

A narrowing of the valve separating the two left heart chambers is known as mitral valve stenosis, sometimes referred to as mitral stenosis.The heart’s main pumping chamber receives less or no blood flow through the constricted valve. The lower left heart chamber, commonly known as the left ventricle, is the primary pumping chamber of the heart.

You may feel exhausted and breathless if you have mitral valve stenosis Other signs include fast or irregular heartbeats, lightheadedness, chest pain, or bloody coughing. Some individuals fail to notice symptoms. Rheumatic fever, a side effect of strep throat, can result in mitral valve stenosis.

Medication or surgical repair or replacement of the mitral valve may be used to treat mitral valve stenosis. Some people simply require yearly checkups. The severity of the condition and whether it is deteriorating determine how it should be treated. Mitral valve stenosis can cause major heart problems if left untreated.

Symptoms

Usually, mitral valve stenosis gets worse gradually. You may not experience any symptoms, or you might have subtle ones for years. Mitral valve stenosis symptoms can appear at any age, including in children.

The following are signs of mitral valve stenosis:

Discomfort or pain in the chest
Breathing problems, especially during physical exertion or when lying down
Accumulation of fluid in the lungs
Coughing up blood
Irregular heart rhythms
Feeling of a beating, fluttering, or rapid heartbeat
A heart murmur, which is an irregular heart sound
Swollen feet or legs
Dizziness or fainting
Fatigue, particularly when engaging in activities

When the heart rate increases, as it does during exercise, symptoms of mitral valve stenosis may develop or worsen. Symptoms may be brought on by anything that creates stress on the body, such as pregnancy or diseases.

If you experience chest pain, a rapid, fluttering, or hammering heartbeat, or experience shortness of breath when exercising, call your doctor right away to schedule an appointment. Your doctor could advise going to a cardiologist.

Causes

Knowing how the heart generally functions may be helpful in understanding the causes of mitral valve illness.

One of the four heart valves that maintain proper blood flow is the mitral valve. Every heartbeat causes the leaflets on each valve to open and close once. Blood flow via the heart to the body may decrease if a valve does not open or close appropriately. Any of the heart valves become smaller with mitral valve stenosis. The reduced valve opening requires the heart to pump blood through it more forcefully. This leads to reduced blood flow to the entire body.

Mitral valve stenosis can be caused by many factors, including:

Rheumatic fever. The most typical cause of mitral valve stenosis is a complication of streptococcal throat infection. This condition is known as rheumatic mitral valve disease when rheumatic fever affects the mitral valve. The signs of valve disease may not appear for several years or even decades following rheumatic fever.
Calcium deposits. Calcium deposits may accumulate around the mitral valve as you age. The structures that support the mitral valve flaps may become narrower as a result. Mitral annular calcification, or MAC for short, is the name of the condition. Symptoms of mitral stenosis can result from severe MAC. Even with surgery, treating it is challenging. Aortic valve issues frequently occur in people with calcium surrounding the mitral valve.
Radiation therapy. The mitral valve may occasionally become thicker and harder as a result of radiation to the chest area. Typically, 20 to 30 years following radiation therapy, heart valve deterioration occurs.
Congenital heart defect.  Although less likely to occur, a baby will be born with a constricted mitral valve that will eventually create issues.
Other health conditions. Rarely, autoimmune diseases like lupus and others can lead to mitral valve stenosis.

Risk factors

These are the risk factors that may lead to mitral valve stenosis:

Untreated strep infections. The likelihood of developing mitral valve stenosis is increased by a history of untreated streptococcal throat infections or rheumatic fever.
Aging. The likelihood of calcium accumulation around the mitral valve is higher in older people.
Radiation therapy. The shape and structure of the mitral valve are altered by radiation. Rarely, patients who get radiation treatment for specific forms of cancer in the chest area may develop mitral valve stenosis.
Use of illegal drugs. The drug MDMA, (3,4-methylenedioxymethamphetamine), increases the risk of developing mitral valve disease.
Use of certain medicines. Patients taking some drugs, have an increased risk of mitral valve stenosis.

If you’re exhibiting any of the symptoms of mitral valve stenosis, consult a cardiologist at Vejthani Hospital The doctor will run tests and diagnose if you have mitral valve stenosis and what treatment methods you need. It may require mitral valve surgery.

Diagnosis

A physical examination, questions about the signs and symptoms, and a medical history are typically used to evaluate whether the patient have mitral valve stenosis.

If during the assessment the specialist hears a heart murmur (whooshing sound of the heart), the patient will be referred to a cardiologist. The medical professional will also listen to your lungs using a stethoscope. An accumulation of fluid in the lungs may result from mitral valve stenosis. Your doctor may refer to this as congestion.

Mitral valve stenosis can be detected using a number of investigations, including:

Echocardiogram. Mitral stenosis can be confirmed by an echocardiogram. Sound waves can be visualized as the heart beating. The examination can detect locations with inadequate blood flow and issues with the heart valves. It may also be used to assess the degree of mitral valve stenosis.

A transducer, which resembles a wand, is used in a typical echocardiogram, also known as a transthoracic echocardiogram, to direct sound waves at the heart. The skin around the chest area is tightly forced against the device.

To view the mitral valve more closely, a transesophageal echocardiography may occasionally be performed. A tiny transducer attached to the end of a tube is placed down the tube going from the mouth to the stomach (esophagus) during this kind of echocardiogram.

Get an echocardiogram every year if you have been told you have very severe mitral stenosis. Every three to five years, people with less severe mitral stenosis should get an echocardiography. How often you will need one, find out from your doctor.

- Electrocardiogram. This rapid and painless test, often known as an ECG or EKG, gauges the electrical activity of the heart. Electrodes are placed on the arms, legs, and occasionally the chest in the form of sticky patches. The electrodes are connected by wires to a computer, which shows the test findings. How quickly or slowly the heart is beating can be seen on an ECG. If there is an irregular heartbeat, a doctor can detect it by observing signal patterns.
- Chest X-ray. The health of the heart and lungs can be seen on a chest X-ray. It can detect cardiac enlargement, which may be an indication of specific heart valve diseases.
- Exercise stress tests. These tests frequently involve using a treadmill or a stationary cycle while the heart rate is being tracked. Exercise tests can assist determine how the heart reacts to exertion and whether signs of valve dysfunction manifest during exercise. If you are unable to exercise, you may be prescribed medication that imitate the positive effects of exercise on the heart.
- Cardiac computed tomography (CT). This examination provides a more thorough cross-sectional view of the heart and the heart valves by combining numerous X-ray images. When mitral stenosis is not brought on by rheumatic fever, a cardiac CT is frequently performed to assess it.
- Cardiac magnetic resonance imaging (MRI). This examination produces fine-grained pictures of the heart using radio waves and magnetic fields. In order to assess the severity of mitral valve stenosis, a cardiac MRI may be performed.
- Cardiac catheterization. Although it is rare, this test may be used to identify mitral stenosis and assess its severity if other tests are ineffective. In a blood vessel, typically in the groin or wrist, a long, thin, flexible tube known as a catheter is placed. It is led toward the heart. To reach the heart’s arteries, dye passes through the catheter. The dye enhances the visibility of the arteries in X-ray and video images.

Staging

Your doctor might inform you of the disease stage if testing reveals that you have mitral or another type of heart valve disease. The best course of treatment can be chosen with the aid of staging.
The degree of the disease, the intensity of the symptoms, the structure of the valve or valves, and blood flow through the heart and lungs all affect the stage of heart valve disease.

The four fundamental stages of heart valve disease are:

Stage A: At risk. There are some risk factors for heart valve disease.
Stage B: Progressive. Mild to moderate valve disease exists and heart valve symptoms are absent.
Stage C: Asymptomatic severe. Extreme valve disease exists but heart valve symptoms are absent.
Stage D: Symptomatic severe. Severe valve disease that manifests symptoms.

Treatment

Patients with mitral valve stenosis often receive treatment from a doctor with training in heart disease. An expert in this field is a cardiologist.

Without symptoms, mild to moderate mitral valve stenosis may not require emergency medical attention. Instead, you’ll visit your doctor routinely to see if your illness worsens.

Medication, open heart surgery, mitral valve replacement, or repair are all forms of treatment for mitral valve stenosis.

Medications

The signs and symptoms of mitral valve stenosis are managed with medication.

The following medicines may be recommended by your doctor:

Diuretics, These water pills alleviate or prevent fluid buildups in any organ of the body, including the lungs.
Blood thinners, also known as anticoagulants, to aid in preventing blood clots if you suffer from an atrial fibrillation-related irregular heartbeat. As atrial fibrillation can cause blood clots and strokes, blood thinners are prescribed to lower the chance of developing any of these complications.
Beta blockers, calcium channel blockers or other heart drugs to slow the heart rate.
Heart rhythm drugs help to treat irregular heartbeats, such as atrial fibrillation. Anti-arrhythmics are the name for these medications.
Antibiotics to prevent rheumatic fever from reoccurring if that is what caused the mitral valve damage.

Surgery or other procedures

Even if you do not have any symptoms, a sick or damaged mitral valve may eventually require repair or replacement. A surgeon might replace or repair your mitral valve at the same time as any other heart surgery you require if you have another heart issue. The treatment plan can be discussed between you and your healthcare professional. The following surgeries and treatments are possible for mitral valve stenosis:

Balloon valvuloplasty. A constricted opening in a mitral valve is repaired with this method. It makes use of a tiny balloon and a catheter, which is a hollow, flexible tube. The balloon-tipped catheter is inserted into an artery by the doctor, typically in the groin. A mitral valve is the target. The mitral valve opening is made wider by the inflation of the balloon. The balloon is then deflated and is taken out along with the catheter.

Valvuloplasty may be performed even if you are asymptomatic. However, not all people with mitral valve stenosis qualify for the operation. To determine whether it’s a possibility for you, discuss with your doctor.

Transcatheter intervention treatment includes this procedure.
The procedure is also known as a percutaneous transvenous mitral commissurotomy, percutaneous mitral balloon commissurotomy, and mitral balloon valvotomy.

Open-heart surgery to repair the valve. An open cardiac surgery called an open valvotomy may be performed if a catheter treatment is not an option. The procedure is also known as a surgical commissurotomy. It eliminates calcium buildup and further scar tissue that are obstructing the mitral valve opening. To stop bleeding in the chest area during this surgery, the heart must be stopped. The heart’s function is temporarily taken over by a heart-lung machine. If the mitral valve stenosis reappears, the treatment might need to be redone.
Mitral valve replacement. If the mitral valve cannot be fixed, it may need to be replaced surgically. A mechanical valve or a biological valve from cow, pig, or human heart tissue is option used to replace the damaged valve. A biological tissue valve is one that is constructed from human or animal tissue.

Over time, biological tissue valves degrade and may require replacement. Blood thinners are required for lifelong in order to prevent blood clots in people with mechanical valves. To select the best option for you, you and doctor should explore the advantages and disadvantages of each type of valve.

The prognosis is typically excellent for those who undergo treatment or surgery for mitral stenosis. But complications after surgery are more likely when the patient is older, in poorer condition, or has a lot of calcium accumulation on or near the valves. The prognosis following valve surgery could be worse by persistent pulmonary hypertension.

Diseases & Conditions Mitral Stenosis Treatment and Surgery