Mitral valve narrowing of the heart: mitral stenosis

By Cristiano Antonino On Mar 20, 2023

Mitral stenosis, or mitral valve stenosis, is a pathological condition that causes narrowing of the heart’s mitral valve; the stenosis impairs the regular flow of blood passing through the outlet between the atrium and left ventricle, which is controlled by the mitral valve

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Mitral stenosis is triggered by rheumatic disease resulting from a streptococcal infection

Other causes of mitral stenosis can be congenital heart defect and calcification of the valve.

Stenosis if neglected can trigger serious cardiac complications.

As a rule, the mitral valve consists of two thin, movable flaps, anchored by cords of tendon to the papillary muscles, which contract together with the left ventricle where they are positioned, preventing the mitral flaps from prolapsing into the left atrium: the edges of the flaps separate when the valve opens, allowing blood to flow from the left atrium to the left ventricle, and come together again when the valve closes, preventing blood from flowing back.

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However, stenosis may occur:

presence of supramitral ring, there will be a ring of fibrous tissue above the mitral valve restricts the passage of blood within the valve; mitral valve ‘parachute’ will see the valve leaflets stretched and connected to a single papillary muscle; if there is thickening and fusion of the leaflets they will no longer be able to move independently of each other.
Mitral stenosis will cause the pressure in the left atrium to increase in order for blood to flow from the atrium into the left ventricle. This will result in increased pressure in the veins that carry blood from the lungs back to the heart, leading to a build-up of fluid in the lungs and pulmonary hypertension, which places an overload on the right ventricle that could end up causing heart failure.

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You may have no symptoms if you have mitral stenosis or you may have mild symptoms that could escalate in a short time

Symptoms include: Shortness of breath, especially when lying down or following physical activity, swelling in the lower limbs, palpitations, dizziness, fainting, an oily cough that may contain traces of blood, chest pain, headaches and difficulty articulating words.

Symptoms may occur or worsen when there is an increase in heart rate. Increased heart activity could cause fluid accumulation in the lungs and breathlessness.

Symptoms tend to occur more between the ages of 30 and 50, but this does not mean that they can occur at any age, even during childhood.

In order to make a correct diagnosis, an electrocardiogram should be taken in order to identify cardiac dilatation and rhythm abnormalities.

By means of a chest X-ray, the dilatation of the left atrium and the condition of the lungs can be checked.

An echocardiogram will identify mitral valve stenosis and determine its severity.

It may be necessary to perform a trans-oesophageal test using a small probe in order to obtain more detailed images of the mitral valve.

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Coronary angiography gives a complete picture of the health of the coronary arteries and heart

Should surgery be necessary, a mechanical or biological prosthesis will be implanted.

The mechanical valve, although stronger, may cause clots to form, so it will be necessary to take anticoagulant medication for life.

Biological valves are recommended for patients over 65 years of age, for those who are prone to haemorrhaging and would find it difficult to take anticoagulants.

Although tissue valves do not require anticoagulants in the long term, they tend to deteriorate over time and will need to be replaced.

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