FABROA, MARIA JESSICA ERLINDA P.

BSN III

MITRAL STENOSIS NARRATIVE PATHOPHYSIOLOGY

An obstruction to blood flowing from the left atrium into the left ventricle is called

Mitral stenosis.This is often caused by rheumatic endocarditis which then progressively

thickens mitral valve leaflets and chordae tendinae. Leaflets often fuse together. Eventually,

the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle.

(Cheever,2018).

The mitral valve is a tri-leaflet valve. It is llocated between the left atrium and the left

ventricle. The typical area of the mitral orifice is between 4 to 6 square centimeters. Within

the normal physiological conditions, the mitral valve opens during the left ventricular diastole

to allow blood to flow from the left atrium to the left ventricle. Mitral valve areas smaller than

2 square centimeters causes an impediment to the blood flow from the left atrium to the left

ventricle. This then produces a gradient of pressure around the mitral valve. As the gradient

through the mitral valve rises, the left ventricle allows the atrial kick to be filled with blood.

Mitral valve area less than 1 square centimeter causes an increase in left atrial pressure.

The normal left ventricular diastolic pressure is 5 mmHg. A pressure gradient across the

mitral valve of 20 mmHg due to severe mitral stenosis will cause a left atrial pressure of

about 25 mmHg. This increased left atrial pressure is transmitted retrograde to the

pulmonary veins and pulmonary capillaries and eventually to the pulmonary arteries. It gives

the patient a feeling of dyspnea. As the left atrial pressure continues to rise, the left atrium

may increase in size. If the left atrium increases in size, there is a higher risk of developing

atrial fibrillation. As atrial fibrillation occurs, the atrial kick is lost. Hence, in severe mitral

stenosis, left ventricular filling depends on the atrial kick. With the loss of the atrial kick, there

is a reduction in cardiac output and a rapid development of congestive heart failure.

The prognosis is excellent in the era of mitral valve replacement. However, prior to

the era of open-heart surgery, the prognosis for most mitral stenosis patients was bad.
Survival is slightly higher in patients undergoing an open mitral valve replacement compared

to a commissurotomy.

REFERENCES:

Cheever, K. H., & Hinkle, J. L. (2018). Brunner & Suddarth's textbook of medical-surgical

nursing. Philadelphia: Wolters Kluwer.

Shah SN, Sharma S. Mitral Stenosis. [Updated 2020 Aug 10]. In: StatPearls [Internet].

Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK430742/