Mitral Valve Stenosis: Treatment Overview

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Treatment Overview

Key points

Treatment of mitral valve stenosis depends on the severity of your symptoms, which can take 10 to 40 years to develop. If you haven't yet developed symptoms or you have mild, stable symptoms, your doctor may only monitor your condition with periodic echocardiograms. As the valve narrows, symptoms will develop or get worse. Repair or replacement of the valve will be necessary to prevent complications such as heart failure.

As you review your treatment options, consider the following:

• Monitoring your condition may be all that's necessary before you develop symptoms or if you have only mild, stable symptoms.
• After symptoms start, your doctor may prescribe medicines to treat them and to prevent complications.
• During monitoring, if your doctor detects increased pressure in your heart and lungs, increased narrowing of the valve, or if your symptoms become severe, your mitral valve will need to be repaired or replaced.
• Whether your valve can be repaired or replaced depends on the condition of the valve. If it is damaged beyond repair, it will need to be replaced with an artificial valve.
• Repair can be noninvasive (balloon valvotomy) or require open-heart surgery (open commissurotomy). Replacement requires open-heart surgery.

Initial treatment

Mitral valve stenosis develops slowly. As the valve narrows, the heart initially compensates by pumping harder. Eventually pressure builds in the upper left side of your heart (left atrium ) as more and more force is needed to push blood across your narrowing mitral valve. This eventually stretches the atrium's walls, weakens the heart, and leads to heart failure. For most people, it takes 10 to 20 years for the mitral valve to narrow enough to produce symptoms. This is called the asymptomatic phase. But if your heart adjusts to the narrowed valve, you may not have symptoms even after your valve has narrowed.

Symptoms most commonly develop when unusual stress places an extra burden on your heart. For example, hard exercise can bring on symptoms. Symptoms in women may develop during pregnancy because of the increased demands that pregnancy makes on the heart.

Ongoing treatment

Your doctor may prescribe medicines to manage the symptoms of mitral valve stenosis that you've developed, such as shortness of breath, and to prevent and treat complications that may develop. These medicines may include:

• Diuretics ("water pills"), which reduce fluid retention and related swelling and which also may lower blood pressure in the upper left heart chamber (left atrium) and relieve breathing difficulties.
• Antiarrhythmics such as digoxin, beta-blockers, or calcium channel blockers, to slow and regulate an irregular and sometimes rapid heartbeat (atrial fibrillation).
• Anticoagulants, such as warfarin, for atrial fibrillation.

Treatment if the condition gets worse

As your mitral valve stenosis gets worse, there will come a time when your doctor will advise repairing or replacing your mitral valve.

Mitral valve repair may be done in one of two ways:

• Balloon valvotomy. A thin flexible tube (catheter) is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon located on the tip of the catheter is quickly inflated. The balloon, pressing against the narrowed mitral valve leaflets, separates and stretches the valve opening and allows more blood to flow through the heart. This procedure does not require open-heart surgery, so recovery is easier.
• Open commissurotomy. This method of repair requires open-heart surgery. A surgeon removes calcium deposits and other scar tissue from the mitral valve leaflets, which opens the valve. This procedure is used for people who have severe narrowing of the valve and are not good candidates for balloon valvotomy.

Mitral valve replacement surgery is also an open-heart procedure. The damaged heart valve is removed and replaced with a new valve. It is generally the last choice in mitral valve stenosis treatment because an artificial mitral valve cannot work as well as a normal mitral valve.

Your doctor will likely recommend valve replacement if the valve has deteriorated to the point that repair is not an option or if the anatomy of the valve has been changed by one or more repair procedures and can no longer be repaired.

See a picture of mitral valve replacement surgery .

Last updated:	March 18, 2008
Author:	Robin Parks, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC