Mitral stenosis (MS) is narrowing of the mitral valve opening that impedes blood flow from the left atrium to the left ventricle. This progressive condition most commonly results from rheumatic fever sequelae and remains a significant cardiac problem globally. Livasa Hospital provides comprehensive MS evaluation and management including medical therapy, percutaneous interventions and surgical correction when appropriate.

Understanding Mitral Stenosis

The mitral valve controls flow during diastole. When stenotic, the narrowed opening restricts flow, causing:

• Elevated left atrial pressure

• Pulmonary venous congestion

• Pulmonary hypertension

• Right ventricular strain

• Atrial fibrillation risk

Aetiology

Most common cause:

• Rheumatic mitral stenosis – From prior rheumatic fever

Less common causes:

• Congenital mitral stenosis

• Degenerative disease (rare)

• Malignancy involvement

Severity Classification

Clinical Presentation

Asymptomatic:

• Often detected by murmur or ECG findings

• May remain stable for years

Symptomatic:

• Dyspnoea with exertion

• Orthopnoea

• Paroxysmal nocturnal dyspnoea

• Palpitations (from atrial fibrillation)

• Fatigue

• Signs of right heart failure in advanced disease

Diagnostic Evaluation

Echocardiography:

• Gold-standard assessment

• Measures valve area using planimetry

• Calculates mean gradient

• Assesses leaflet morphology

• Evaluates other valve disease

• Detects left atrial thrombus

ECG:

• Atrial fibrillation

• Left atrial enlargement

• Right ventricular hypertrophy

Chest X-ray:

• Signs of pulmonary congestion

• Enlarged left atrium

Cardiac catheterization:

• Rarely needed for diagnosis

• May be used for pressure measurements

• Coronary angiography if surgery planned

Thromboembolic Risk

MS patients, especially with atrial fibrillation, have elevated stroke risk from:

• Left atrial stasis and thrombus formation

• Atrial fibrillation-related thromboembolism

Anticoagulation (warfarin or DOAC) is essential in many MS patients.

Treatment Strategy

Asymptomatic with normal pressures:

• Medical observation

• Regular echocardiographic surveillance

• Anticoagulation if AF present

Symptomatic or pulmonary hypertension:

• Intervention indicated

Percutaneous balloon mitral valvotomy (PBMV):

• Minimally invasive catheter-based procedure

• Separates fused commissures

• Excellent results in suitable anatomy

• High success rate (>90%)

Surgical mitral commissurotomy:

• Traditional surgical approach

• For severe calcification unsuitable for PBMV

Mitral valve replacement:

• For severe disease unsuitable for repair

Percutaneous Balloon Mitral Valvotomy Procedure

Key steps:

1. Transoesophageal echocardiographic guidance

2. Transseptal puncture to access left atrium

3. Balloon catheter positioning across mitral valve

4. Sequential balloon inflation to separate leaflets

5. Assessment of adequacy of dilation

6. Echocardiographic confirmation

Success criteria:

• Valve area increase to >1.5 cm²

• Minimal mitral regurgitation

• No complications

Post-Intervention Management

• Regular echocardiographic follow-up

• Anticoagulation based on AF status

• Activity recommendations

• Monitoring for restenosis

Surgical Approaches

When PBMV not suitable:

Mitral commissurotomy:

• Surgical separation of fused commissures

• Median sternotomy approach

Mitral valve replacement:

• Prosthesis choice based on patient factors

Why Choose Livasa Hospital?

• Experienced interventional cardiologists for PBMV

• Transoesophageal echocardiographic expertise

• Cardiac surgical capability for surgical approaches

• Comprehensive valve surveillance programs

NAP – Contact Details

Livasa Hospital Mohali
Sector 71, Sahibzada Ajit Singh Nagar (SAS Nagar)
Mohali, Punjab – 160071
Phone: +91-80788 80788 (24/7 Emergency)
Website: www.livasahospitals.com

Call +91-80788 80788 to schedule mitral stenosis evaluation at Livasa Hospital.