Rheumatic Mitral Valve Stenosis: Diagnosis and Treatment Options
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Purpose of Review
This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS).
While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Pre-procedural evaluation for treatment of MS using a multimodality approach with 2D and 3D transthoracic and transesophageal echo, stress echo, cardiac CT scanning, and cardiac MRI as well as hemodynamic assessment by cardiac catheterization is discussed. The current methods of percutaneous mitral balloon commissurotomy (PMBC) and surgery are also discussed. New data on long-term follow-up after PMBC is also presented.
For severe rheumatic MS, medical therapy is ineffective and definitive therapy entails PMBC in patients with suitable morphological mitral valve (MV) characteristics, or surgery. As procedural outcomes depend heavily on appropriate case selection, definitive imaging and interpretation are crucial. It is also important to understand the indications as well as morphological MV characteristics to identify the appropriate treatment with PMBC or surgery.
KeywordsRheumatic heart disease Rheumatic fever Mitral stenosis Percutaneous intervention Percutaneous mitral balloon valvuloplasty Commissurotomy Echocardiography Closed mitral valve commissurotomy Open surgical mitral commissurotomy
Atrial septal defect
Group A β-hemolytic streptococcus
Rheumatic heart disease
Left atrial appendage
Mitral valve area
Pulmonary arterial hypertension
Percutaneous mitral balloon commissurotomy
Compliance with Ethical Standards
Conflict of Interest
Nina C. Wunderlich, Bharat Dalvi, Siew Yen Ho, Harald Küx, and Robert J. Siegel declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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