Etiology
I: Organic
Rheumatic heart disease: the most common cause. More common in
females and develops about 20 years after the causative rheumatic
activity
Congenital: as in parachute mitral valve.
LA myxoma.
Calcific MS in old age
II: Functional
• Austin-Flint: due to elevation of anterior mitral cusp by AR jet.
• Carry-Coombs: due to oedema of the cusp in acute rheumatic fever
• Increased blood flow across the mitral valve as in MR
Treatment
1. Medical
Prophylaxis against rheumatic activity or infective endocarditis
Treatment of complications e.g. Lung congestion (by diuretics), AF(by digitalis
and anticoagulants) and treatment of chest infections
2. Surgical
o Method:
Valvotomy(closed or open)
Valve replacement: in cases associated with MR, or markedly fibrosed or calcified
valve.
o Indications:
1. Tight mitral stenosis (MVA< 1 cm2).
2. Embolization with no significant patient incapacitation
3. Severe symptoms not controlled by medical treatment
o Complications:
1- Mitral incompetence
2- Restenosis
3- Embolization
4- Arrhythmia
5- Infective endocarditis
6- Post-Cardiotomy syndrome
7- Complications of prosthetic valves
• Thrombo-embolism
• Mechanical dysfunction e.g. stuck valve
• Hemolytic anemia
• Complications of anticoagulation
3. Balloon valvotomy
This is indicated when:
- Stenosis results from commissural fusion with minimal calcification or involvement
of the subvalvular structures.
-Patient unfit for surgery
• Early operation before development of pulmonary hypertension gives the best results
• In patients with pulmonary hypertension, post surgical reduction of PAP can be
predicted preoperatively by dobutamine or nitrate infusion effect on PAP
• Prophylaxis against infective endocarditis is essential following valvotomy or valve
replacement
• Anticoagulants after valve replacement is needed to prevent thromboembolism(INR
kept around 2-3)