Cardiothoracic Surgery: Mitral Stenosis (MS)

Mitral Stenosis (MS)

Definition

  • Definition: Stenosis & Narrowing of the Mitral Valve
  • Causes Increased Pressure in the Left Atrium, Pulmonary Vasculature & Right Heart
  • Left Ventricle is Spared

Causes

  • Rheumatic Fever with Mitral Commissural Fusion – Most Common Cause
  • Annular Calcification
  • Congenital Mitral Stenosis

Symptoms

  • Exertional Dyspnea – Most Common Symptom & Often the Only Symptom
  • Decreased Exercise Tolerance
  • Chest Pain
  • Fatigue
  • Pulmonary Edema
  • Right Heart Failure
  • *Symptoms are Uncommon Until Disease is Severe

Diagnosis

  • Diagnosis: Echocardiogram
  • Severity:
  Mild Moderate Severe
Valve Area > 1.5 cm2 1.0-1.5 cm2 < 1.0 cm2
Mean Gradient < 5 mmHg 5-10 mmHg > 10 mmHg
Pulmonary Artery Systolic Pressure < 30 mmHg 30-50 mmHg > 50 mmHg
  • Stage:
    • Stage A: At Risk for MS
    • Stage B: Progressive (Mild-Moderate) MS
    • Stage C: Asymptomatic Severe MS
    • Stage D: Symptomatic Severe MS

General Management

  • Asymptomatic MS: Monitoring for Disease Progression
    • Medical Management of Heart Failure & Arrhythmia
  • Symptomatic Severe MS: Mitral Balloon Valvulotomy/Commissurotomy
    • Also Consider for Asymptomatic Very Severe MS
    • Contraindications:
      • Unfavorable Valve Morphology
      • Left Atrial Thrombus
      • Moderate-Severe Mitral Regurgitation (MR)
  • Mitral Valve Surgery
    • Procedure: Repair vs. Replacement
    • Indications:
      • Failure of Mitral Balloon Valvulotomy
      • Severe Symptomatic MS with Contraindication to Mitral Balloon Valvulotomy
      • Moderate-Severe Symptomatic MS Undergoing Cardiac Surgery for Other Indications