Mitral valve stenosis is a narrowing of the mitral valve opening that causes blood to back up in the lungs. The main cause is rheumatic fever which causes thickening and scarring of the mitral valve leaflets. As the opening narrows below 2 cm^2, it causes increased pressure in the lungs and left atrium that can lead to heart failure, pulmonary hypertension, and atrial fibrillation. Diagnosis is made through echocardiogram and symptoms of exertional dyspnea, orthopnea, and cough. Treatment options include medications, surgical repair or replacement of the mitral valve, and percutaneous mitral valvuloplasty using a balloon catheter.

1. Mitral valve stenosis
Kim Chung Nguyen. MD
Head of General Cardiovascular Department
Tam Đuc Hospital

2. Mitral stenosis is a valvular heart disease characterized by the
narrowing of the orifice of the mitral valve .
Normal MV area 4-6 cm2. MVA < 2.5 cm2 lead to symptoms
Mitral stenosis with marked
thickening of the leaflets and left
atrial hypertrophy
Normal mitral valve

3. Causes of MS
• Almost all cases:
- The heart secondary to rheumatic fever # rheumatic heart disease.
• Uncommon causes:
- Calcification of the MV leaflets or annular
- Infective endocarditis where the vegetations may favor increase risk of
stenosis.
- Left atrial myxoma
- Congenital MS
• Other rare causes:
- Endomyocardial fibroelastosis
- Systemic lupus erythematosus.

5. Pathophysiology (1)
• MV orifice is 4-6 cm2: MV opens
during LVd blood the LA  LV - not
impede this blood flow, pressures in
the LA and the LVd will be equal. 
LV gets filled during early LVd, only a
small portion of extra blood
contributed by contraction of the
LA(the "atrial kick") during late LVd

6. Pathophysiology (2)
• MV area < 2 cm2: An impediment
blood into the LV , creating a
pressure gradient across the MV 
increases in the HR ,CO. When the
HR goes above a certain point, the
diastolic filling period is insufficient,
pressure  in the LA, leading to
pulmonary congestion

7. Pathophysiology (3)
• MV area < 1 cm2: Increased LAP (to push blood through
the stenotic valve: 10--- 20mmHg). LAP causes
pulmonary hypertension Pulmonary capillary pressures
an imbalance between the hydrostatic and the oncotic
pressure, pooling of fluid in the lungs (congestive HF
causing PE)
• the LA to increase in size:to develop atrial fibrillation (AF)-
the atrial kick is lost
• HF + LA dilation+ AF : LA , systemic embolization
• MS typically progresses slowly 20-30ys,the initial signs
NYHA II , development of AF fibrillation NYHA III or IV .
Once an individual develops NYHA class III or IV

8. : dyspnea on exertion, orthopnea and
paroxysmal nocturnal dyspnea (PND)

9. Clinical findings
• Hoarseness: compression of the left recurrent laryngeal nerve
(LRLN) by enlarged LA
• Persistent cough: Enlarged LA compress to bronchi and
pulcongestion
• Mitral facies: Pinkish purpule patches on the cheeks due to
decreased CO and vasoconstriction
• Palpation: The arterial pulses are reduced due to the decreased of
SV
• Pulses may be irregular in Afib
• A P2 may be palpable in the the 2nd left intercostal space (2nd LICS)
• Moist rales, pleural effusion

10. Physical examination
• S1 is usually loud because of increased force in closing the MV.
• S2 (P2) loud and late If pulmonary hypertension secondary
• Opening snap: A high-pitch additional sound after S2( severity of the MS , the
pressure in the  LA , and MV opens earlier, leaflets suddenly tense and dome into
the LVd.
• A mid-diastolic rumbling murmur with presystolic accentuation after the opening
snap. The diastolic murmur is low-pitch sound, heard best with the bell of the
stethoscope, rolling pt toward left

12. Imaging Tests
1. Echocardiogram:
- LA enlargement, thick and calcified MV"fish-mouth"shaped orifice
- RV Hypertrophic
- The trans-mitral gradient as measured by Doppler echocardiography is the gold
standard in the evaluation of the severity of MS
• Transesophageal echocardiogram (TEE):Wilkins scoring system to assess MV
morphology and its relationship to the success of percutaneous balloon dilation of
the MV

14. 2

16. 3

17. Diagnosis of MS

18. (1)

19. Management (2)
1. Medical management:
• Anticoagulants (blood thinners)
• Diuretics (to reduce fluid buildup through increased urine output)
• Antiarrhythmics (medications to treat abnormal heart rhythms)
• Beta-blockers (medications to slow your HR)
2.MV repair or replacement by surgery: The replacement might be biological (from a
cow, pig, or human cadaver), or mechanical. Repair is better than replacement
3.Percutaneous mitral valvuloplasty by balloon catheter :moderate or severe MS ,
nonpliable calcified valve, NYHA III–IV, and either are not candidates for surgery or
are at high risk with surgery