Mitral Stenosis Overview
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Questions and Answers

What is the primary cause of mitral stenosis?

  • Rheumatoid arthritis
  • Rheumatic fever (correct)
  • Infective endocarditis
  • Systemic lupus erythematosus

Which of the following is NOT a typical pathological change seen in rheumatic mitral stenosis?

  • Thinning of the valve leaflets (correct)
  • Shortening of the chordae tendineae
  • Fusion of the mitral commissures
  • Calcification of the valve leaflets

Where do thrombi typically form in patients with mitral stenosis and atrial fibrillation?

  • In the coronary arteries
  • In the left atrium, particularly the appendage (correct)
  • In the left ventricle
  • In the aortic arch

What is the normal range for the mitral valve orifice area in adults?

<p>4-6 cm² (C)</p> Signup and view all the answers

In addition to rheumatic fever, which of these can lead to obstruction of left ventricular inflow?

<p>Cor triatriatum (A)</p> Signup and view all the answers

Besides the initial cause of mitral stenosis, what else can exacerbate the chronic changes of the valve?

<p>Inflammation, fibrosis, and trauma due to altered flow (B)</p> Signup and view all the answers

Which valve shape is characteristic of severe rheumatic mitral stenosis?

<p>Funnel-shaped 'fish mouth' (D)</p> Signup and view all the answers

In which region is mitral stenosis still a major health concern, despite global decline?

<p>Low-income countries in Sub-Saharan Africa (B)</p> Signup and view all the answers

What is the most likely explanation for limited symptomatic improvement following a mitral commissurotomy?

<p>The presence of pre-existing or induced mitral regurgitation or associated valvular disease. (A)</p> Signup and view all the answers

For a patient with mitral stenosis (MS), which of the following valve areas would be classified as severe, often requiring intervention?

<p>An orifice area of ≤1.5 cm². (B)</p> Signup and view all the answers

When is mitral commissurotomy indicated for a pregnant patient with mitral stenosis?

<p>When pulmonary congestion occurs despite maximum medical treatment. (C)</p> Signup and view all the answers

In patients undergoing mitral valve replacement (MVR), what is a significant factor that affects the perioperative mortality rate?

<p>The patient's age, left ventricular function, pre-existing heart disease and associated illnesses. (C)</p> Signup and view all the answers

What is a key measure taken during mitral valve replacement (MVR) to help optimize the recovery of left ventricular function?

<p>Preservation of the chordal connections. (D)</p> Signup and view all the answers

What is the typical overall 10-year survival rate for patients who survive surgical intervention for mitral stenosis?

<p>Approximately 70%. (C)</p> Signup and view all the answers

Apart from age, what factor significantly contributes to a worse long-term prognosis following mitral stenosis surgery?

<p>Marked preoperative disability and depression of cardiac output. (C)</p> Signup and view all the answers

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 ?

<p>An orifice area ≤1.5 cm² with NYHA Class III symptoms. (A)</p> Signup and view all the answers

Flashcards

Mitral Stenosis Pathophysiology

Chronic inflammation caused by rheumatic fever leads to thickening of the mitral valve leaflets with fibrous tissue growth and calcific deposits. The valve narrows, becoming funnel-shaped, with stiff, fused leaflets.

Leading Cause of Mitral Stenosis

Rheumatic fever is the primary cause of mitral stenosis, leading to valve thickening, fusion, and stiffness.

Normal Mitral Valve Orifice Area

A measurement of the mitral valve orifice area in healthy adults; a crucial indicator of valve function

What is Mitral Stenosis?

It is the narrowing of the mitral valve opening, hindering blood flow from the left atrium to the left ventricle.

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What is Mitral Stenosis?

The narrowing of the mitral valve opening, hindering blood flow from the left atrium to the left ventricle.

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What are the pathological changes in rheumatic mitral stenosis?

In rheumatic MS, the mitral valve leaflets become thick, stiff, and fused due to chronic inflammation.

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How does mitral stenosis develop?

Mitral stenosis develops due to the inflammation and thickening of the mitral valve, often caused by rheumatic fever.

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What are the main causes of mitral stenosis?

Mitral stenosis is a narrowing of the mitral valve opening caused by various conditions, with rheumatic fever being the leading cause, especially in developing countries. Other causes include congenital valve defects and connective tissue disorders.

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Mitral Commissurotomy

A medical procedure that widens a narrowed mitral valve opening, improving blood flow from the left atrium to the left ventricle.

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Mitral Stenosis (MS)

A condition where the mitral valve is narrowed, restricting blood flow from the left atrium to the left ventricle.

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Surgical Mitral Commissurotomy

A type of mitral valve repair where the leaflets of the valve are directly stitched together to enlarge the valve opening.

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Mitral Valve Area (Valve Area)

The area of the mitral valve opening, measured in square centimeters, which determines the amount of blood flow through the valve.

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Mitral Valve Replacement (MVR)

A procedure used to replace a severely damaged mitral valve with an artificial one.

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New York Heart Association (NYHA) Functional Class

The classification of heart failure based on symptoms and limitations.

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Percutaneous Mitral Balloon Commissurotomy (PMBC)

A method of performing mitral commissurotomy using echocardiographic guidance, minimizing the need for X-rays.

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Mitral Regurgitation (MR)

A condition where the mitral valve leaks, allowing blood to flow backward into the left atrium.

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Study Notes

Mitral Stenosis

  • 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.

  • 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).

  • 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.

  • 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.

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