Mitral Valve Stenosis

What is mitral valve stenosis?

Mitral valve stenosis (sometimes called mitral stenosis) is a narrowing or blockage of the mitral valve inside your heart. Over time, this condition can cause heart rhythm problems and a higher risk of stroke. It may lead to heart failure and death.

A narrow mitral valve makes it harder for blood to flow from the left atrium (upper chamber) to the left ventricle (lower chamber) on the left side of your heart. This is because the valve can’t open as much as it should to let blood go through. It’s like a door that can’t open all the way.

Your mitral valve is the first valve that blood passes through after traveling through your lungs to collect oxygen. Getting blood to your left ventricle is important because it sends oxygen-rich blood to all your body’s cells.

Common causes of mitral valve stenosis include an allergic or immune reaction to a bacterial infection and calcification of the valve. Children can also have mitral valve stenosis when they’re born (congenital). It can also happen late in life.

How common is mitral valve stenosis?

Mitral valve stenosis is an uncommon disease, especially in developed countries. It affects about 1 out of every 100,000 people in the U.S. It’s more common in developing countries, especially when there’s limited access to antibiotics and medical care.

Mitral valve stenosis is much more likely to happen in females. In developed countries, people in their 50s and 60s make up the majority of mitral valve stenosis cases. In developing countries, it’s a more common diagnosis in younger adults.

When it happens in infants and children, healthcare providers find most cases before the age of 2. It may also run in families, increasing the risk of having it if one of your relatives also has it.

What are the symptoms of mitral valve stenosis?

The most common mitral valve stenosis symptoms are:

• Shortness of breath. This is the most common symptom. It usually happens during physical activity and exercise but can also happen while lying down.
• Fatigue. More than being tired, this describes when you feel exhausted to the point that it interferes with your normal activities.
• Bronchitis. Infections usually cause this. If you have mitral valve stenosis, you may get these infections more often.
• Heart palpitations (where you become unpleasantly aware of your own heartbeat). This often happens when mitral valve stenosis puts more pressure on the upper left chamber of your heart, causing an irregular heart rhythm called atrial fibrillation.
• Stroke. When your heart isn’t pumping blood in its upper chambers as effectively, a clot can form because of the reduced blood flow. This clot can then travel from your heart to your brain, where it can get into a smaller blood vessel and cause a stroke.
• Cough with blood. This sometimes happens when the limited blood flow puts pressure not just on the upper chamber of your heart but also on the veins in your lungs.
• Hoarseness. One of the nerves that controls your vocal cords runs next to your heart. Increased pressure in the upper chamber of your heart can put pressure on this nerve. Just as your leg can fall asleep if there’s pressure on one of its nerves for too long, your voice may give out if this nerve is under enough pressure.
• Swelling in your abdomen, ankles or feet. This happens when your heart is struggling to pump effectively, causing fluid to build up.

Children who are born with mitral stenosis often have these symptoms:

• Trouble feeding or sweating while feeding. This symptom is one of the most common indicators of mitral valve stenosis in infants.
• Cough. This may also include wheezing or struggling to breathe.
• Slowed growth. This means that the child’s height, weight and other indicators are lower than expected for their age.
• Frequent respiratory infections.
• Shortness of breath. This is especially common. It may cause older children to tire out easily when they’re active.

If you have mild or moderate mitral valve stenosis, you may not have any symptoms. Many women who have mitral stenosis don’t know it until they develop symptoms during pregnancy. This is because, when you're pregnant, your heart works harder to provide blood for both your needs and those of a fetus.

What causes mitral valve stenosis?

Mitral valve stenosis causes include:

• Damage from infections: Rheumatic fever is the most common cause of mitral valve stenosis. Often called rheumatic mitral stenosis, this happens when your immune system damages the valve while fighting an untreated bacterial infection. Rheumatic mitral stenosis gets worse over time. Rheumatic mitral stenosis is most common in people around age 50, and the diagnosis is usually years or even decades after the infection happened. That’s because it may take years or decades before the damage to your heart valve causes symptoms or appears on a medical exam.
• Wear and tear due to age: This type of stenosis is more likely with advancing age and results from calcium buildup on the valve. But many people with age-related mitral stenosis have only mild or moderate narrowing and may not need treatment. Typically, calcification occurs naturally as we age but certain conditions, like kidney disease or radiation, can accelerate it.
• Present at birth. Providers usually detect congenital (present at birth) mitral stenosis before the age of 2. This kind of stenosis can range from mild to severe. If not treated, children with severe mitral stenosis typically don’t survive past age 5.

What are the risk factors for mitral valve stenosis?

Mitral valve stenosis risk factors include:

• Having rheumatic fever.
• Being female.
• Having a relative with mitral valve stenosis.

What are the complications of mitral valve stenosis?

Mitral valve stenosis complications include:

• Difficulty swallowing from an enlarged upper chamber compressing your esophagus.
• Pulmonary hypertension (high blood pressure in the arteries that bring blood to your lungs).
• Pulmonary edema (fluid in your lungs).
• Heart failure (a heart that can’t pump as well as it should).
• Blood clots.
• Atrial fibrillation (an irregular heart rhythm).
• Stroke.
• Infective endocarditis (an infection in your heart valves).
• Sudden death.

How is mitral valve stenosis diagnosed?

Your primary care provider may detect symptoms of mitral stenosis during a regular checkup and refer you to a specialist. One of the easiest signs of mitral stenosis for a healthcare provider to detect is a heart murmur. Your provider can usually hear a murmur when using a stethoscope to listen to your heart and breathing during a routine physical exam. More severe cases can cause more than one sound as part of the murmur, which can help your provider determine the severity of your case.

What tests will be done to diagnose mitral valve stenosis?

A cardiologist will usually do one or more of the following tests to diagnose your case and determine its severity:

• Echocardiogram. This test uses ultrasound waves to give healthcare providers a picture of the inside of your heart. It’s the most common test used to diagnose mitral valve stenosis.
• Electrocardiogram (ECG or EKG). This measures the electrical activity of your heart using sensors attached to the skin on your chest. An EKG can detect heart rhythm problems connected to mitral valve stenosis.
• Chest X-ray. X-rays can show telltale changes in the shape or structure of your heart that mitral valve stenosis causes.
• Cardiac catheterization. A provider inserts a device into one of your blood vessels and threads it up to your heart. Then they can measure pressures within your heart and determine if you have mitral valve stenosis.

Stages of mitral valve stenosis

Healthcare providers may talk about mitral valve stenosis stages. These range from A to D, with D being the most severe. At each stage, a provider may see irregularities in how your mitral valve looks or functions. Stages C and D have the most severe issues. You don’t have symptoms until stage D.

How is mitral valve stenosis treated?

Mitral valve stenosis treatments can manage — but not cure — your condition. Once you have symptoms, it’s important to get mitral valve stenosis treatment sooner rather than later. By the time symptoms begin, the problem is often past the mild stage.

Some treatments, especially valve repair or replacement, can stop or reduce your symptoms for years. Other treatments, like medication, can also help by preventing complications.

Medication to manage symptoms

Several different types of medicine (like beta-blockers, diuretics or blood thinners) can treat symptoms of mitral valve stenosis. Some of these drugs also treat or prevent:

• High blood pressure.
• Symptoms of heart failure (especially swelling from too much fluid).
• Fast heart rhythms.
• Blood clots and stroke.

Your provider may also prescribe a long-term course of antibiotics to prevent heart valve damage.

Catheter-based procedures to alter or replace your valve

For these procedures, a healthcare provider inserts a catheter into an artery in your body. They advance the catheter up to your heart and use it to repair or replace your valve.

• Valvuloplasty or balloon valvotomy: This procedure involves a catheter with a balloon attached. Your provider can inflate the balloon when it reaches your mitral valve. This can widen the narrowed area.
• Valve replacement: In some cases, it’s possible to replace a valve using a catheter-based procedure. This is called transcatheter mitral valve replacement or TMVR.

Surgery to repair or replace your valve

A surgeon can use many different methods for mitral valve repair, including minimally invasive surgery or robotically assisted surgery. People with mitral valve stenosis from rheumatic heart disease may have a commissurotomy. This separates the areas where your valve’s flaps fused together or got too thick.

Depending on your case and your needs, your surgeon may recommend either repairing the valve or replacing it altogether. Your new valve may contain animal tissue, artificial materials or both. Your provider can help you choose the best option.

Complications/side effects of the treatment

Complications of mitral valve stenosis treatment may include:

• Dizziness.
• Bleeding.
• Infection.
• Heart failure.
• Heart attack.
• Stroke.
• Severe mitral regurgitation (leaky valve).
• Blood clots.
• Abnormal heart rhythms.
• Issues with artificial valves.

How long does it take to recover from this treatment?

Recovery time for mitral valve stenosis repair or replacement procedures depends on the method. Surgical methods take the longest. You may need to stay in the hospital for days, and it may be weeks before you recover fully.

Methods that use a catheter-based approach have much faster recovery times. Most people can go home either the same day or the next day and recover fully in days or a few weeks.

Can mitral valve stenosis be prevented?

In many cases, yes. Treating bacterial infections can prevent many cases of mitral valve stenosis. Most cases happen because of unrecognized — and therefore untreated — bacterial infections. Don’t wait to treat a bacterial infection like strep throat or scarlet fever. Follow your healthcare provider’s instructions closely. Take any prescribed antibiotics and other medications according to the instructions — and not just until you feel better.

You usually can’t prevent mitral stenosis that happens because of aging. However, you may be able to delay when it happens by exercising regularly, maintaining a weight that’s healthy for you, eating a healthy diet and getting an annual checkup.

You can’t prevent the kind of mitral stenosis that you’re born with.

What can I expect if I have mitral valve stenosis?

It can take years or even decades before mitral valve stenosis symptoms develop, especially when rheumatic fever is the cause. Many people don’t develop mitral valve stenosis for 20 to 40 years after they first had rheumatic fever.

Once you develop symptoms, the progression of the disease usually speeds up. Your prognosis depends on how active/functional you are at baseline. People with more severe symptoms like shortness of breath have a worse prognosis than those without. For people who’ve developed high blood pressure in their lungs because of mitral valve stenosis, that survival time is around three years. Heart failure is common in advanced cases.

For children born with mitral valve stenosis, the outlook strongly depends on the severity of their case. Many people born with mitral valve stenosis may need screening for related heart problems for the rest of their lives.

The best outcomes from mitral valve stenosis happen with early detection and timely treatment. Because mitral valve stenosis usually causes a heart murmur, your healthcare provider can often catch it when they listen to your heart during an annual physical exam or checkup. This can help detect and treat it before it becomes severe or advanced.

How do I take care of myself?

Your healthcare provider can help guide you through what you can do to manage mitral valve stenosis. They may recommend:

• Follow-up monitoring and testing every six months to three years (depending on severity).
• Limits on how active you are if you have severe or advanced mitral valve stenosis. This can reduce the strain on your heart.
• A low-salt diet.
• Medication to slow your heartbeat or prevent complications like stroke, heart failure or high blood pressure.

When should I see my healthcare provider?

If you develop the symptoms of mitral valve stenosis, especially ones that disrupt your life, you should contact your healthcare provider.

When should I go to the ER?

After starting a new medication, you should go to the ER if you:

• Have an unexpected side effect from your medicine. Your healthcare provider can tell you which side effects need immediate medical attention.
• Faint or pass out for any reason.
• Take blood thinners and suffer a fall. Blood thinners significantly increase the risk of internal bleeding — especially after a fall or another injury — which can be deadly.
• Have shortness of breath that suddenly gets worse.

After a surgery or catheter procedure, you should go to the ER if:

• Your incision site becomes red, swollen or hot to the touch. These are signs of an infection that needs immediate treatment.
• You faint or have shortness of breath, chest pain or heart palpitations.
• You take blood thinners and suffer a fall or are unable to control bleeding like severe nosebleeds, throwing up blood or blood in your stool (poop).

What questions should I ask my doctor?

Questions to ask your provider may include:

• What stage is my mitral valve stenosis?
• Which treatment would be best for me?
• Should my family get checked for mitral valve stenosis?