MITRAL STENOSIS
MITRAL STENOSIS
- Rheumatic fever is the leading cause of mitral stenosis.
- The valve leaflets are diffusely thickened by fibrous tissue and/or calcific deposits, resulting in narrowing at the apex of the funnel-shaped (fish-mouth) valve
- The mitral valve orifice is normally about 4-6 cm2 in diastole
- When the orifice area is reduced to < 2 cm2, blood can flow from the LA to LV only if propelled by an abnormally elevated left atrioventricular pressure gradient (hemodynamic hallmark of MS)
- Reduced to 1 cm2 or less in severe mitral stenosis
- Patients usually remain asymptomatic until the stenosis is approximately 2 cm2 or less.
| Symptoms | Signs |
|
♦ Loud first heart sound,opening snap ♦ Mid-diastolic murmur
|
- ECG: bifid P waves (P mitrale)
Severe MS
- Malar flush
- Parasternal heave
- Shorter duration of 52-OS gap
- Longer duration of mid diastolic murmur
X-ray
- Prominence of main pulmonary artery
- Enlarged LA and normal RA – double shadow of right heart border
- Straightening of upper left border of heart
- Backward displacement of esophagus by enlarged LA
- Splaying of sub carinal angle (> 120°) due to elevation of left main bronchus
Mitral valvuloplasty is the treatment of choice in MS if the following criteria are fulfilled
- Significant symptoms
- Isolated MS
- No or trivial MR
- Mobile, non-calcified valve on ECHO
- Left atrium free of thrombus
TREATMENT:
- Avoid exertion
- fever (increased lA pressure), treat AF and CHF
- increase diastolic filling time (beta-blockers, digitalis)
Exam Important
- Pregnant patient will be benefited by having a forceps-assisted vaginal delivery at the time of delivery in case of MS
- Features of Mitral stenosis on X-ray are Double contour of right border,Pulmonary hemosiderosis,Straightening of left heart border, Lifting of left main bronchus ,Posterior displacement of esophagus on barium swallow& Splaying of carinal angle
- In Patient with mitral stenosis with some liver compromise Xenon inhalational agent is preferred for surgery
- In Pregnant patient with H/o MS & MR for normal delivery best analgesia is Epidural anaesthesia
- In Pregnant patient with mitral stenosis class II and Rheumatic heart disease Give Prophylactic antibiotics, Apply Outlet forceps in 2nd stage of labor & Give iv furosemide at delivery of placenta
- In Pregnant patient with mitral stenosis class II and Rheumatic heart disease Methergin at delivery is contraindicated
- Surgical correction of mitral stenosis during pregnancy is ideally done at14 weeks
- A case of severe mitral stenosis is associated with Pulsatile liver, Atrial fibrillation & Increase in the length of murmur
- A patient known to have mitral stenosis and atrial fibrillation, presents with acute onset of weakness in the left upper limb which recovered completely in two weeks. The most likely diagnosis is Ischemic stroke
- Most common heart disease associated with pregnancy is Mitral stenosis
- Surgery for mitral stenosis during pregnancy is ideally done at 14 weeks
- During pregnancy corrective cardiac surgery is commonly indicated in Mitral stenosis
- In a diastolic murmur in mitral area with ECG showing mitral valve orifice to be 0.8 cm2. The cause of her murmur is Severe mitral stenosis
- Loud S1 in Mitral stenosis is seen in Prolonged flow through mitral valve
- Kerley B lines seen in Mitral stenosis
- A 25 year old primigravide with mitral stenosis and mitral regurgitation is under labor. She wants normal delivery which would be the best way to provide analgesia in this lady Neuraxialblockde analgesia
- Mid-diastolic Murmur with presystolic accentuation is typically seen in Mitral stenosis
- A wide and notched P wave is typically seen in MS
- Mitral stenosis is associated with Right ventricular hypertrophy
- Pulsatile liver, Atrial fibrillation & prolonged murmur is seen as severity of mitral stenosis increases
- Severity of mitral stenosis is assessed by Length of murmur & S2-OS gap
- MC cause of morbidity and mortality late in the course of mitral stenosis Recurrent pulmonary emboli
- Austin Flint Murmur is commonly mistaken for the murmur of Mitral stenosis
- An old lady with mitral stenosis underwent hysterectomy for uterine fibroid and died after developing pulmonary edema. The order of cause of death in international certificate is Pulmonary edema, hysterectomy, mitral stenosis
- A wide and notched P wave is typically seen in MS
- Heart sounds heard in chronic mitral stenosis is Mid diastolic murmur, Opening snap & Loud S I
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