Treatment of Mitral Stenosis
Treatment considerations are relied on the symptom severity, severity of stenosis, the existence or risk of complications, age of diagnosis, condition of the valve and the heart.
Condition of the valve and heart, severity of the stenosis is characterized by echocardiography,
severe: less than 1.5cm2,
very severe: less than 1cm2.
Complications of the disease: Mitral regurgitation, Atrial fibrillation, pulmonary edema, pulmonary hypertension, tricuspid regurgitation, cerebrovascular embolism, sinus tachicardia, Right ventricular heart failure, endocarditis
cerebrovascular embolism,
Penicillin profilaxis for rheumatic heart disease:
When: History of rheumatic fever and Asymptomatic patients
Pros: Preventive treatment, oral administration or monthly IM injections
Cons: Very long duration of treatment, compliance issues
When: Mildly symptomatic, Pulmonary edema
Cons: Not sufficient for moderate and severe stenosis, risk of Electrolite imbalance / ototoxicity / dehidration
Beta blockers or Calcium channel blockers
When: Control of ventricular rate if sinus tachicardia or AF is present
Cons: Asthma or COPD execerbation (BBlockers)
Warfarin (do not use direct acting oral anticoagulants)
When: To prevent thromboembolism (emboli history, AF, left atrial clot, enlarged left atrium)
Cons: Risk of bleeding, regular INR follow up, drug interactions, teratogen
Percutaneous balloon commissurotomy
When: Young, without valvular calcification / subvalvular distortion / severe MR / left atrium thrombi
Pros: Minimal invasive, as effective as open heart surgery, lower complications
Cons: Limitations of the procedure, need for valvular replacement in the long run for certain cases.
When: Contraindications with percutaneous intervention except valvular calcification
Rarely done in modern days
Cons: Need for sternotomy or thoracotomy, invasive
When: If the valve is not suitable for perc. or surg. commissurotomy
Pros: Effective, treatment of last resort
Cons: Highly invasive, lifelong warfarin for mechanical valves, 3-6m warfarin for bioprothesis, high mortality and morbidity