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1530890
Mitral stenosis
Description
Mind Map on Mitral stenosis, created by ben.ramsay on 10/26/2014.
Mind Map by
ben.ramsay
, updated more than 1 year ago
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Created by
ben.ramsay
over 10 years ago
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Resource summary
Mitral stenosis
Association with Rheumatic heart disease
25% of patients with rheumatic heart disease have isolated MS
40% of patients with rheumatic heart disease have combined MS/MR
Other associated diseases
Malignant carcinoid diseae
SLE
Rheumatoid Arthritis
Fabry syndrome
Whipple disease
Mitral annular calcification
Common in elderly
Causes functional stenosis
Rarely causes severe disease
Mitral valve orifice measurements (mid diastole)
Normal : 4-6cm
<2cm: moderate MS
<1cm: severe MS
<4cm: Mild MS
Clinical presentations
Common
Dyspnoea/Fatigue/ Reduced ETT
Causes include: reduced CO, PHT, reduced vital capacity
Insidious onset, often masked by patient changes in lifestyle
Palpitations and embolic events
Secondary to AF either permanent or paroxysmal
Rare
Chest pain
Clinically indistinguishable from Angina
Haemoptysis
Sudden-onset and severe
Caused by big increases in LA pressure and associated bronchial vein rupture
"Ortner Syndrome"
Hoarsness of voice in MS patient
Caused by LA enlargement pressing on recurrent laryngeal nn.
Physical exam findings
AF: most common
"Mitral Facies"
Pink-purple pacths on cheeks
Auscultatory findings
Diastolic, low-pitched rubbing murmur (longer duration = severity)
Opening Snap, just after A2 (sooner after A2 = severity)
Loud P2 (sign of PHT)
If any auscultatory findings become palpable = severity
Clinical Outcomes/Sequale
Natural History
NYHA3 Dyspnoea: 65% 5yr survival
NYHA4 Dyspnoea: 12% 5yr survival
AF
Incidence related to age, not severity of MS
Likley treatment resistant
Systemic embolism
20% of patients have sinus rhythm!
Depends on LA dilation and appendage thromboses
PHT
Endocarditis
Increased risk as compared to population
much lower risk than MR or aortic valve disease
Treatment
Medical
Managing complications
AF
Rhythm control often ineffective
Anticoagulation at higher INR
Dyspnoea
Diuretics and salt restriction
Monitoring disease
Mild disease
3rd annually Echo
Moderate disease
2nd annually Echo
Severe Disease
Annual echo
Valvulotomy
Contraindications (all assessed on pre-op TOE)
Co-existing MR
Thrombus in LAA
Unsuitable anatomic findings eg, heavily calcified valves, cordae thickening and shortening
Indications
Asymptomatic disease
Moderate-Severe disease
co-existant PHT
Symptomatic disase
Mod-severe disease
Mild disease controlled medically
Outcomes
Equal to open repair in appropriately selected patients
Early BMV may prevent development of AF
Permanent MR a complication
Open Repair
All other patients with disease severity as per BMV but otherwise contraindicated
Patients with recurrent embolic events despite anticoagulation
Comissurotomy, valve decalcified, cordae separated and split
Atrial maze/atrial ablation procedure often dose at same time
Mitral valve replacement
Most often for patients with combined MS/MR
Patients with previous valvulotomy or repair
Metallic valves for patients under 65 to avoid the possibility of repeat operation
Bioprosthetic valves for all patients over 65 or those who anticoagulation is contraindicated
Ongoing symptoms after valvulotomy or replacement?
Six possibilities
Valve restenosis
Technically inadequate procedure
Worsened MR
Aortic valve disease
Coronary artery disease
Infective endocarditis
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