Mitral valve stenosis is a condition in which the opening to the mitral valve of the heart is narrowed, preventing the valve from opening normally and restricting blood flow into the pumping chamber of the heart. This makes the heart work harder to move blood through the narrowed valve into the left ventricle, which is the chamber that pumps blood to the body. Mitral valve stenosis has become less common in the United States today because the condition’s primary cause, rheumatic fever, has decreased in frequency.

Causes of mitral valve stenosis

Mitral valve disease can be caused by rheumatic fever, a complication of strep throat or a congenital heart defect.

Mitral valve stenosis can weaken the heart, leading to heart failure, atrial fibrillation, enlargement of the heart, lung congestion and blood clot.

Symptoms of mitral valve stenosis

Mild cases of heart valve disease may not cause symptoms. The most common symptoms include:

• Palpitations caused by irregular heartbeats
• Fatigue
• Shortness of breath
• Swelling in the feet and ankles
• Respiratory infections
• Coughing

Symptoms may worsen with exertion or stress.

How Ohio State diagnoses mitral valve stenosis

Mitral valve stenosis may be suspected if a physician detects abnormal heart sounds through a stethoscope. To further define the nature and extent of the valve disease, physicians may use tests including:

• Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.
• Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart.
• Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine.
• Cardiac catheterization – A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
• Transesophageal echocardiogram (TEE) – A test to provide an image of heart structures; a small transducer (like a microphone) is passed down the esophagus to produce the image.

How Ohio State treats mitral valve stenosis

Medications

Drugs prescribed to treat mitral valve stenosis include diuretics (or water pills), anticoagulants (or blood thinners), beta-blockers, and calcium channel blockers.

Surgery and procedures

When an intervention is necessary to “fix” mitral stenosis, it can be done either surgically or using a catheter approach (similar to a cardiac catheterization). The surgical options include mitral valve replacement or mitral valve repair (sometimes called a valvuloplasty), where the surgeon opens up the restricted valve leaflets to decrease the degree of stenosis and improve the blood flow. This valvuloplasty procedure can sometimes be done in the cath lab, using a balloon to spread the valve leaflets and open the valve. This latter approach does not require open heart surgery.

Increasingly at Ohio State, mitral valve surgery is being performed using minimally invasive surgery including robotic heart surgery, resulting in smaller incisions and quicker healing.