Mitral valve stenosis

Diagnosis
Your doctor will ask about your medical history and give you a physical examination that
includes listening to your heart through a stethoscope. Mitral valve stenosis causes an
abnormal heart sound, called a heart murmur.

Your doctor also will listen to your lungs to check lung congestion — a buildup of fluid in your
lungs — that can occur with mitral valve stenosis.

Your doctor will then decide which tests are needed to make a diagnosis. For testing, you may
be referred to a cardiologist.

Diagnostic tests
Common tests to diagnose mitral valve stenosis include:

Transthoracic echocardiogram. Sound waves directed at your heart from a wandlike device
(transducer) held on your chest produce video images of your heart in motion. This test is
used to confirm the diagnosis of mitral stenosis.
Transesophageal echocardiogram. A small transducer attached to the end of a tube
inserted down your esophagus allows a closer look at the mitral valve than a regular
echocardiogram does.
Electrocardiogram (ECG). Wires (electrodes) attached to pads on your skin measure
electrical impulses from your heart, providing information about your heart rhythm. You
might walk on a treadmill or pedal a stationary bike during an ECG to see how your heart
responds to exertion.
Chest X-ray. This enables your doctor to determine whether any chamber of the heart is
enlarged and the condition of your lungs.
Cardiac catheterization. This test isn't often used to diagnose mitral stenosis, but it might
be used when more information is needed to assess your condition. It involves threading a
thin tube (catheter) through a blood vessel in your arm or groin to an artery in your heart and
injecting dye through the catheter to make the artery visible on an X-ray. This provides a
detailed picture of your heart.

Cardiac tests such as these help your doctor distinguish mitral valve stenosis from other heart
conditions, including other mitral valve conditions. These tests also help reveal the cause of
your mitral valve stenosis and whether the valve can be repaired.
Treatment
If you have mild to moderate mitral valve stenosis with no symptoms, you might not need
immediate treatment. Instead, your doctor will monitor the valve to see if your condition
worsens.

Medications
No medications can correct a mitral valve defect. However, certain drugs can reduce symptoms
by easing your heart's workload and regulating its rhythm.

Your doctor might prescribe one or more of the following medications:

Diuretics to reduce fluid accumulation in your lungs or elsewhere.

Blood thinners (anticoagulants) to help prevent blood clots. A daily aspirin may be included.
Beta blockers or calcium channel blockers to slow your heart rate and allow your heart to fill
more effectively.
Anti-arrhythmics to treat atrial fibrillation or other rhythm disturbances associated with
mitral valve stenosis.
Antibiotics to prevent a recurrence of rheumatic fever if that's what caused your mitral
stenosis.

Procedures
You may need valve repair or replacement to treat mitral valve stenosis, which may include
surgical and nonsurgical options.

Percutaneous balloon mitral valvuloplasty

In this procedure, also called balloon valvotomy, a doctor inserts a soft, thin tube (catheter)
tipped with a balloon in an artery in your arm or groin and guides it to the narrowed valve. Once
in position, the balloon is inflated to widen the valve, improving blood flow. The balloon is then
deflated, and the catheter with balloon is removed.

For some people, balloon valvuloplasty can relieve the signs and symptoms of mitral valve
stenosis. However, you may need additional procedures to treat the narrowed valve over time.

Not everyone with mitral valve stenosis is a candidate for balloon valvuloplasty. Talk to your
doctor to decide whether it's an option for you.

Mitral valve surgery

Surgical options include:

Commissurotomy. If balloon valvuloplasty isn't an option, a cardiac surgeon might perform

open-heart surgery to remove calcium deposits and other scar tissue to clear the valve
passageway. Open commissurotomy requires that you be put on a heart-lung bypass
machine during the surgery. You may need the procedure repeated if your mitral valve
stenosis redevelops.
 Mitral valve replacement. If the mitral valve can't be repaired, surgeons may perform mitral
valve replacement. In mitral valve replacement, your surgeon removes the damaged valve
and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue
(biological tissue valve).

Biological tissue valves degenerate over time, and often eventually need to be replaced.
People with mechanical valves will need to take blood-thinning medications for life to
prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of
valve and discuss which valve may be appropriate for you.

Lifestyle and home remedies

To improve your quality of life if you have mitral valve stenosis, your doctor may recommend
that you:

Limit salt. Salt in food and drinks may increase pressure on your heart. Don't add salt to
food, and avoid high-sodium foods. Read food labels and ask for low-salt dishes when
eating out.
Maintain a healthy weight. Keep your weight within a range recommended by your doctor.
Cut back on caffeine. Caffeine can worsen irregular heartbeats (arrhythmias). Ask your
doctor about drinking beverages with caffeine, such as coffee or soft drinks.
Seek prompt medical attention. If you notice frequent palpitations or feel your heart racing,
seek medical help. Fast heart rhythms that aren't treated can lead to rapid deterioration in
people with mitral valve stenosis.
Cut back on alcohol. Heavy alcohol use can cause arrhythmias and make symptoms worse.
Ask your doctor about the effects of alcohol on your heart.
Exercise. How long and hard you're able to exercise may depend on the severity of your
condition and the intensity of exercise. But everyone should engage in at least low-level,
regular exercise for cardiovascular fitness. Ask your doctor for guidance before starting to
exercise, especially if you're considering competitive sports.
See your doctor regularly. Establish a regular appointment schedule with your cardiologist
or primary care provider.

Women with mitral valve stenosis need to discuss family planning with their doctors before
becoming pregnant. Pregnancy causes the heart to work harder. How a heart with mitral valve
stenosis tolerates the extra work depends on the degree of stenosis and how well the heart
pumps. Throughout your pregnancy and after delivery, your cardiologist and obstetrician should
monitor you.

Preparing for your appointment

Your family doctor may be the first to suspect mitral valve stenosis. After your initial
appointment, your doctor may refer you to a doctor who specializes in heart conditions
(cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

 Write down your symptoms and when they started.
List your key medical information, including other health problems and prescription and
over-the-counter medications and supplements you're taking.
Take a family member or friend to the appointment, if possible. Someone who
accompanies you can help remember the information you get.
Write down the questions to ask your doctor.

Questions to ask your doctor at your initial appointment include:

What is likely causing my symptoms?
Are there other possible causes for these symptoms?
What tests do I need?
Should I see a specialist?
Do I need to restrict anything before my cardiologist appointment?

Questions to ask if you are referred to a cardiologist include:

What is my diagnosis?
What treatment do you recommend?
What are the possible side effects of the medications you're recommending?
What will my recovery be like from the procedure you're recommending?
How will you monitor my health over time?
What is my risk of long-term complications from this condition?
What restrictions do I need to follow?
Will physical activity, including sex, increase my risk of complications?
What diet and lifestyle changes should I make?
I have these other health problems. How can I best manage them together?

It's important for you to understand your condition. Don't hesitate to ask other questions.

What to expect from your doctor

A doctor or cardiologist who sees you for possible mitral valve stenosis may ask:

What are your symptoms?

When did your symptoms begin?
Have your symptoms worsened?
Do you have rapid, fluttering or pounding heartbeats?
Have you coughed up blood?
Does exercise or physical activity worsen your symptoms?
Are you aware of a family history of heart problems?
Have you had rheumatic fever?
Are you being treated or have you recently been treated for any other health conditions?
 Do you or did you smoke? How much? When did you quit?
Do you use alcohol or caffeine? How much?
Are you planning to become pregnant in the future?

What you can do in the meantime

While you wait for your appointment, ask family members whether close relatives have cardiac
disease. The symptoms of mitral valve stenosis are similar to other heart conditions, including
some that run in families. Knowing about your family's health history will help your doctor
determine your diagnosis and treatment.

If exercise makes your symptoms worse, avoid exerting yourself physically until you've seen
your doctor.

By Mayo Clinic Staff

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