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Mitral Valve Stenosis – Causes, Symptoms & Treatment

Mitral valve stenosis is a narrowing of the mitral valve in the heart that restricts blood flow from the left atrium into the left ventricle.

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Things worth knowing about "Mitral Valve Stenosis"

Mitral valve stenosis is a narrowing of the mitral valve in the heart that restricts blood flow from the left atrium into the left ventricle.

What Is Mitral Valve Stenosis?

Mitral valve stenosis (also known as mitral stenosis) is a heart valve disease in which the mitral valve – the valve between the left atrium and the left ventricle – becomes abnormally narrowed. Under normal conditions, this valve opens widely to allow oxygen-rich blood from the lungs to flow freely into the left ventricle. When stenosis is present, this opening is chronically restricted, forcing the heart to work harder and causing blood to back up into the left atrium and lungs.

Causes

The most common cause of mitral valve stenosis worldwide is rheumatic fever, an inflammatory condition that can develop as a complication of untreated streptococcal throat infection. This causes the valve leaflets to fuse and scar, leading to permanent narrowing. Other possible causes include:

Congenital malformations of the mitral valve
Calcification of the valve structures in older age
Rare inflammatory conditions such as systemic lupus erythematosus
Radiation therapy to the chest area (as a late complication)

Symptoms

In the early stages, mitral valve stenosis often causes no symptoms. As the narrowing progresses, the following symptoms may develop:

Exertional dyspnea: Shortness of breath during physical activity, and later at rest
Palpitations or irregular heartbeat (often due to atrial fibrillation)
Cough, sometimes with blood-tinged sputum (hemoptysis)
Fatigue and reduced exercise tolerance
Fluid retention (edema) in the legs or lungs
Dizziness or fainting episodes during exertion

Diagnosis

Mitral valve stenosis is diagnosed using several investigations:

Physical examination: A physician can detect a characteristic mitral opening snap and a diastolic heart murmur using a stethoscope.
Echocardiography (cardiac ultrasound): The primary investigation for assessing valve opening area, severity, and cardiac function.
Electrocardiogram (ECG): May reveal signs of atrial fibrillation or left atrial enlargement.
Chest X-ray: Can show an enlarged left atrium or pulmonary congestion.
Cardiac catheterization: Used when precise pressure measurements or coronary artery assessment is needed.

Severity Grading

Mitral valve stenosis is classified by valve opening area:

Mild: Opening area greater than 1.5 cm²
Moderate: Opening area 1.0–1.5 cm²
Severe: Opening area less than 1.0 cm²

Treatment

Medical Therapy

Medical treatment cannot eliminate the stenosis itself but can relieve symptoms and prevent complications. Commonly used medications include:

Diuretics to manage fluid retention and congestion symptoms
Beta-blockers or calcium channel blockers for heart rate control
Anticoagulants (blood thinners) in patients with atrial fibrillation to prevent stroke
Antibiotic prophylaxis in patients at risk of rheumatic fever recurrence

Interventional and Surgical Treatment

For moderate to severe stenosis with symptoms, the following procedures are considered:

Percutaneous balloon mitral valvuloplasty (PBMV): A catheter-based procedure in which a balloon is inserted into the narrowed valve and inflated to widen it. This is the preferred treatment when valve anatomy is suitable.
Surgical mitral valve repair: Open-heart surgical correction of the valve.
Mitral valve replacement: Replacement of the diseased valve with a mechanical or biological prosthesis when repair is not feasible.

Prognosis and Outlook

Mitral valve stenosis typically progresses slowly, and many patients remain symptom-free for years. Without treatment, serious complications can arise, including heart failure, atrial fibrillation, stroke from blood clots, or pulmonary hypertension (elevated blood pressure in the lungs). After successful intervention or surgery, symptoms improve significantly in most cases.

References

Vahanian A. et al. – 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 2022; 43(7): 561–632.
Carabello B.A. – Mitral Stenosis. In: Zipes D.P. et al. (eds.), Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th edition, Elsevier, 2022.
World Health Organization (WHO) – Rheumatic Heart Disease. Fact Sheet. Available at: https://www.who.int (accessed 2024).

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