IIntroduction

The mitral valve — which lies between the two

chambers on the left side of your heart — consists of
two triangular-shaped flaps of tissue called leaflets.
The leaflets of the mitral valve connect to the heart
muscle through a ring called the annulus. Anchoring
the mitral valve to the left ventricle are tendon-like
cords, resembling the strings of a parachute, called
chordae tendineae cordis.
The mitral valve is forced open when blood flows from
the left atrium into the left ventricle
When a valve becomes narrowed and blood flow
through it is limited, the condition is called stenosis
Mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the
narrowing of the orifice of the mitral valve of the heart.

Causes :-

Rheumatic fever-

Rheumatic fever is the most common cause of mitral valve

stenosis. It can damage the mitral valve in two main ways.
The infection may cause the leaflets of the valve to
thicken, limiting the valve's ability to open. Or the
infection may cause the leaflets of the mitral valve to fuse
somewhat together, preventing the valve from opening
and closing properly. People with rheumatic fever may
conti……
Congenital heart defect:-
A heart valve fails to develop properly in a newborn,
infant or child.
predominant MS occurs in approximately 40% of
all patients with rheumatic heart disease
predominant MS occurs in approximately 40% of
all patients with rheumatic heart disease.
Pathophysiology
Right Heart Failure:  Pulmonary HTN
Hepatic Congestion
JVD Pulmonary Congestion
Tricuspid Regurgitation Atrial Fib
RA Enlargement LA Thrombi
LA Enlargement
 LA Pressure

RV Pressure Overload
RVH
RV Failure LV Filling
Contin…….
Normal valve area: 4-6 cm2
Mild mitral stenosis:
MVA 1.5-2.5 cm2
Minimal symptoms
Moderate mitral stenosis
MVA 1.0-1.5 cm2 usually does not produce symptoms
at rest
Severe mitral stenosis
MVA < 1.0 cm2
Symptoms
Fatigue, especially during times of increased
activity .
Shortness of breath, especially with exertion or
when you lie down
Swollen feet or ankles
Heart palpitations — sensations of a rapid,
fluttering heartbeat
Frequent respiratory infections, such as bronchitis
Heavy coughing, sometimes with blood-tinged
sputum
Rarely, chest discomfort or chest pain
Diagnostic evaluations
Echocardiography-which shows left atrial enlargement,
thick and calcified mitral valve with narrow and "fish-
mouth"-shaped orifice and signs of
right ventricular failure in advanced disease..
Cardiac chamber catheterization-The right heart
catheterization (commonly known as Swan-Ganz
catheterization) gives the physician the mean
pulmonary capillary wedge pressure, which is a
reflection of the left atrial pressure. The left heart
catheterization, on the other hand, gives the pressure in
the left ventricle.
Continu…..
Chest X ray- shows left atrial enlargement.
Electro cardiography
Complications
Heart failure:- A narrowed mitral valve interferes
with blood flow through your heart and from your
heart out to the rest of your body.
Heart enlargement
Atrial fibrillation:- In mitral valve stenosis, the
stretching and enlargement of your heart's left
atrium may lead to a heart rhythm irregularity
called atrial fibrillation.
Blood clots :-
atrial fibrillation can put you at risk of blood clots
forming in the upper left chamber of your heart,
where blood pools in mitral valve stenosis.
Contin…..
Lung congestion. Another possible complication of
mitral valve stenosis is pulmonary edema — a
condition in which blood and fluid back up into your
lungs. This causes congestion of the lungs, leading to
shortness of breath and, sometimes, coughing up of
blood-tinged sputum.