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Surgical management of mitral stenosis

Matthew J Sorrentino, MD, FACC
Section Editors
Catherine M Otto, MD
Gabriel S Aldea, MD
Edward Verrier, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Mitral stenosis (MS) is a condition characterized by obstruction of blood flow across the mitral valve from the left atrium to the left ventricle. The mechanical obstruction leads to increases in pressure within the left atrium, pulmonary vasculature, and right side of the heart. Most cases of MS are caused by rheumatic heart disease with mitral commisural adhesion, thickened immobile mitral valve leaflets, fibrosis, thickening, shortening, fusion, and calcification of the chordae tendinae. Infrequent causes of MS include mitral annular calcification and congenital MS (including parachute mitral valve). (See "Pathophysiology and natural history of mitral stenosis", section on 'Etiology'.)

If untreated, MS often progresses to significant symptoms (eg, dyspnea and fatigue) and serious complications (eg, pulmonary edema, systemic arterial embolism, pulmonary hypertension, and death). Medical therapy can relieve symptoms but surgical or percutaneous intervention is required to relieve the obstruction to flow. (See "Medical management and indications for intervention for mitral stenosis".)

Surgical approaches to MS are reviewed here. Issues directly related to the indications for intervention and choice of percutaneous mitral balloon valvotomy versus surgery and the medical management of MS are discussed separately. (See "Percutaneous mitral balloon valvotomy for mitral stenosis" and "Medical management and indications for intervention for mitral stenosis".)


Rheumatic MS — When intervention is warranted in patients with rheumatic mitral stenosis (MS), the 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines recommend percutaneous mitral balloon valvotomy (PMBV) if the valve morphology is favorable and the patient does not have left atrial thrombus or moderate to severe (3+ to 4+) mitral regurgitation (figure 1 and table 1)[1]. The data supporting this conclusion are presented separately. (See "Percutaneous mitral balloon valvotomy for mitral stenosis", section on 'PMBV versus surgery'.)

However, even with unfavorable anatomy, PMBV may be performed as a palliative procedure if the patient is deemed to be at high risk for surgery and there is no left atrial thrombus or moderate to severe mitral regurgitation. (See "Percutaneous mitral balloon valvotomy for mitral stenosis", section on 'Choice of PMBV'.)


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Literature review current through: Sep 2016. | This topic last updated: Mar 20, 2015.
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