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Rheumatic Mitral Valve Stenosis: Diagnosis and Treatment Options

  • Structural Heart Disease (RJ Siegel and NC Wunderlich, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

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.

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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

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Authors and Affiliations

  1. Cardiovascular Center Darmstadt, Darmstadt, Germany

    Nina C. Wunderlich & Harald Küx

  2. Glenmark Cardiac Centre, Mumbai, India

    Bharat Dalvi

  3. Cardiac Morphology Unit, Royal Brompton Hospital, London, England

    Siew Yen Ho

  4. The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Robert J. Siegel

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  1. Nina C. Wunderlich
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Correspondence to Nina C. Wunderlich.

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Wunderlich, N.C., Dalvi, B., Ho, S.Y. et al. Rheumatic Mitral Valve Stenosis: Diagnosis and Treatment Options. Curr Cardiol Rep 21, 14 (2019). https://doi.org/10.1007/s11886-019-1099-7

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