Mitral valve stenosis

Mitral valve stenosis is relatively rare, and is characterized by a narrowed (stenotic) mitral valve between the left atrium and the left ventricle.

What is mitral valve stenosis?

The mitral valve is a bicuspid valve, i.e. has two valve leaflets, and is situated between the left ventricle and the left atrium. The chordae tendineae and papillary muscles connect the valve leaflets to the ventricle walls.
The term mitral valve stenosis refers to a narrowing of the mitral valve orifice that results in impaired filling of the left ventricle.

The condition can be caused by degenerative changes or can develop as a result of inflammatory processes that cause damage to the valve leaflets and chordae tendineae. Mitral valve stenosis leads to a pressure gradient between the left ventricle and the left atrium, which results in atrial enlargement, i.e. a distension of the atrium. Possible consequences can include heart failure and pulmonary edema. Patients with more advanced disease may develop pulmonary hypertension (an increase in blood pressure in the pulmonary arteries) and right-sided heart failure, or even atrial fibrillation.

Mitral valve stenosis used to be a very common type of valve disease. However, due to comprehensive disease control programs aimed at scarlet fever and streptococcal infections, rheumatic fever is now extremely rare - as is mitral valve stenosis.

What are the main symptoms?

Classical symptoms include:

  • Reduced exercise capacity
  • Shortness of breath (dyspnea), usually upon exertion
  • Persistent cough
  • Acute pulmonary edema
  • Small amounts of blood-tinged (russet-brown) sputum
  • Atrial fibrillation, associated with an increased risk of pulmonary embolism and stroke

What are possible causes?

In the majority of cases, the condition develops as a result of rheumatic heart disease or congenital heart problems.

Fig. 2: Transthoracic echocardiography

Diagnosis of mitral valve stenosis

  • First suspicions are usually raised during a physical examination
  • Listening to the heart with a stethoscope (auscultation): distinctive heart sounds
  • ECG evidence of atrial fibrillation
  • Transthoracic echocardiography – or in some cases transesophageal echocardiography - is necessary to diagnose and determine the severity of mitral valve stenosis. (see Fig. 1 and 2)
  • Cardiac catheterization is used in order to exclude coronary heart disease

Treatment for mitral valve stenosis

The selection of treatment depends on whether the patient has symptomatic or asymptomatic disease.
Initially, treatment is targeted at alleviating the symptoms typically associated with the disease, such as atrial fibrillation and heart failure.
Patients with more severe cases of mitral valve stenosis can be treated surgically, with possible options including mitral valve replacement or mitral valve reconstruction. In certain cases, the Brandenburg Heart Center can offer a catheter-based procedure to widen the mitral valve (mitral valvuloplasty).

Step-by-step treatment process:

  • Avoidance of strenuous physical activity
  • Drug-based treatment of heart failure and atrial fibrillation
  • Oral anticoagulants, particularly in patients with atrial fibrillation
  • Percutaneous balloon valvuloplasty (widening of the mitral valve) using a catheter-based approach
  • Mitral valve surgery to either repair the mitral valve or to replace it (with artificial or tissue valves)

Relevant information

Emergency numbers

  • Emergencies only:
    Our emergency room:
    +49 3338-69 45 21

Contact person

  • Univ.-Prof. Dr. med.
    Christian Butter
    Head of the Department of Cardiology, Immanuel Hospital Bernau Brandenburg Heart Center

    PA to Head of Department Christine Meinecke
    Immanuel Hospital Bernau Brandenburg Heart Center
    Ladeburger Str. 17
    16321 Bernau bei Berlin
    T +49 3338 694-610
    F +49 3338 694-644
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