Podcast
Questions and Answers
What is the primary cause of mitral stenosis?
What is the primary cause of mitral stenosis?
Which of the following is NOT a typical pathological change seen in rheumatic mitral stenosis?
Which of the following is NOT a typical pathological change seen in rheumatic mitral stenosis?
Where do thrombi typically form in patients with mitral stenosis and atrial fibrillation?
Where do thrombi typically form in patients with mitral stenosis and atrial fibrillation?
What is the normal range for the mitral valve orifice area in adults?
What is the normal range for the mitral valve orifice area in adults?
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In addition to rheumatic fever, which of these can lead to obstruction of left ventricular inflow?
In addition to rheumatic fever, which of these can lead to obstruction of left ventricular inflow?
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Besides the initial cause of mitral stenosis, what else can exacerbate the chronic changes of the valve?
Besides the initial cause of mitral stenosis, what else can exacerbate the chronic changes of the valve?
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Which valve shape is characteristic of severe rheumatic mitral stenosis?
Which valve shape is characteristic of severe rheumatic mitral stenosis?
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In which region is mitral stenosis still a major health concern, despite global decline?
In which region is mitral stenosis still a major health concern, despite global decline?
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What is the most likely explanation for limited symptomatic improvement following a mitral commissurotomy?
What is the most likely explanation for limited symptomatic improvement following a mitral commissurotomy?
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For a patient with mitral stenosis (MS), which of the following valve areas would be classified as severe, often requiring intervention?
For a patient with mitral stenosis (MS), which of the following valve areas would be classified as severe, often requiring intervention?
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When is mitral commissurotomy indicated for a pregnant patient with mitral stenosis?
When is mitral commissurotomy indicated for a pregnant patient with mitral stenosis?
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In patients undergoing mitral valve replacement (MVR), what is a significant factor that affects the perioperative mortality rate?
In patients undergoing mitral valve replacement (MVR), what is a significant factor that affects the perioperative mortality rate?
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What is a key measure taken during mitral valve replacement (MVR) to help optimize the recovery of left ventricular function?
What is a key measure taken during mitral valve replacement (MVR) to help optimize the recovery of left ventricular function?
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What is the typical overall 10-year survival rate for patients who survive surgical intervention for mitral stenosis?
What is the typical overall 10-year survival rate for patients who survive surgical intervention for mitral stenosis?
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Apart from age, what factor significantly contributes to a worse long-term prognosis following mitral stenosis surgery?
Apart from age, what factor significantly contributes to a worse long-term prognosis following mitral stenosis surgery?
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For patients requiring mitral valve replacement (MVR), what specific condition is noted as an important factor that could suggest MVR may be needed, before surgery ?
For patients requiring mitral valve replacement (MVR), what specific condition is noted as an important factor that could suggest MVR may be needed, before surgery ?
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Study Notes
Mitral Stenosis
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Etiology and Pathology:
- Leading cause is rheumatic fever.
- Other causes include congenital mitral valve stenosis, cor triatriatum, mitral annular calcification, systemic lupus, rheumatoid arthritis, left atrial myxoma, and infective endocarditis.
- Rheumatic heart disease with MS occurs in ~40% of cases.
- Incidence has decreased due to reduced rheumatic fever, but remains a prevalent problem in low-income countries.
- Chronic inflammation causes leaflet thickening, fibrosis, and calcification.
- Commissures fuse, chordae tendineae fuse/shorten, cusps become rigid leading to narrowing.
- Later changes can be exacerbated by altered flow patterns.
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Pathophysiology:
- Normal mitral valve orifice is 4-6 cm2.
- Significant obstruction reduces the orifice area.
- Narrowing of valve may lead to thrombus formation within the left atrium, particularly in the left atrial appendage in patients with atrial fibrillation (AF).
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Mitral Commissurotomy:
- Indicated for symptomatic patients (NYHA Class II-IV) with isolated severe MS and an effective orifice area of 1.5 cm2 or less.
- About half of patients require reoperation by 10 years.
- Preferred strategy (PMBC) in pregnant patients with pulmonary congestion.
- Usually performed with transesophageal echocardiography (TEE) and minimal x-ray exposure.
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Mitral Valve Replacement (MVR):
- Necessary for patients with MS and significant mitral regurgitation (MR).
- Necessary for valves severely distorted from previous procedures.
- Necessary if commissurotomy is not successful in significantly improving valve function.
- Routine procedure with preserved chordal attachments, for optimal left ventricular (LV) recovery.
- Perioperative mortality rates vary with age, LV function, coronary artery disease (CAD), and comorbidities.
- Average 5% overall.
- Higher in patients >65 years and those with significant comorbidities.
- Long-term complications of valve replacement exist.
- Patients should only be operated on if they have severe MS (orifice area ≤1.5 cm2) and are in NYHA Class III.
- 10-year survival of surgical survivors is ~70%.
- Prognosis is worse for patients >65 with significant disability or with depressed cardiac output preoperatively.
- Pulmonary hypertension and right ventricular (RV) dysfunction are additional risk factors.
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Description
This quiz covers the etiology, pathology, and pathophysiology of Mitral Stenosis, focusing on its leading causes, structural changes in the mitral valve, and clinical implications. Learn about the prevalence in different demographics and the significance of chronic inflammation in this condition.
