I. Pathophysiology

  1. Increased LA pressure leads to pulmonary edema
  2. Y descent (diastole) is flattened
  3. Leads to :
  1. LA hypertrophy
  2. Pulmonary edema
  3. Pulmonary hypertension, leading to RVH

II. Diagnosis

  1. EKG--notched P waves (means LA hypertrophy)
  2. Heart Sounds-see "Cardiac Murmurs"

III. Clinical presentation

  1. Intol. to any tachycardia (tachycardia reduces time of diastole disproportionately)dyspnea, pulmonary edema
  2. Thromboembolism
    1. In a series of 534 adults w/mitral stenosis followed for avg. 37mos, 9% of those in sinus rhythm and 12% of those in AFib had an evident systemic embolic event; for pts in sinus rhythm, older age, presence of left atrial thrombus on transthoracic echocardiography (which all pts had at intake), and significant aortic regurgitation were independently ass'd with risk of embolism. 48% of pts were on anticoagulants (Ann. Int. Med 128:885, 1998--JW)
  3. Bacterial endocarditis

IV. Treatment

  1. Mitral valve replacement
  2. Open commisurotomy
  3. Percutaneous balloon mitral commissurotomy
  4. Closed commissurotomy (worse outcomes than w/other 2 techniques--Circ. 97:245, 1998--JW)