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Rheumatic Mitral Valve Stenosis: Diagnosis and Treatment Options

  • Nina C. WunderlichEmail author
  • Bharat Dalvi
  • Siew Yen Ho
  • Harald Küx
  • Robert J. Siegel
Structural Heart Disease (RJ Siegel and NC Wunderlich, Section Editors)
  • 82 Downloads
Part of the following topical collections:
  1. Topical Collection on Structural Heart Disease

Abstract

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).

Recent Findings

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.

Summary

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.

Keywords

Rheumatic heart disease Rheumatic fever Mitral stenosis Percutaneous intervention Percutaneous mitral balloon valvuloplasty Commissurotomy Echocardiography Closed mitral valve commissurotomy Open surgical mitral commissurotomy 

Abbreviations

3D

Three-dimensional

2D

Two-dimensional

AF

Atrial fibrillation

ASD

Atrial septal defect

CT

Computed tomography

GAS

Group A β-hemolytic streptococcus

ICE

Intracardiac echocardiography

RF

Rheumatic fever

RHD

Rheumatic heart disease

LA

Left atrium

LAA

Left atrial appendage

LV

Left ventricle

MR

Mitral regurgitation

MS

Mitral stenosis

MV

Mitral valve

MVA

Mitral valve area

PAH

Pulmonary arterial hypertension

PMBC

Percutaneous mitral balloon commissurotomy

PHT

Pressure-half-time

SR

Sinus rhythm

TTE

Transthoracic echocardiography

TEE

Transesophageal echocardiography

TSP

Transseptal puncture

Notes

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Nina C. Wunderlich
    • 1
    Email author
  • Bharat Dalvi
    • 2
  • Siew Yen Ho
    • 3
  • Harald Küx
    • 1
  • Robert J. Siegel
    • 4
  1. 1.Cardiovascular Center DarmstadtDarmstadtGermany
  2. 2.Glenmark Cardiac CentreMumbaiIndia
  3. 3.Cardiac Morphology UnitRoyal Brompton HospitalLondonEngland
  4. 4.The Heart InstituteCedars-Sinai Medical CenterLos AngelesUSA

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