Mitral valve stenosis in the current era: a changing landscape

Abstract

Mitral stenosis results from haemodynamic obstruction at the mitral valve level because of structural abnormalities of the valve apparatus, leading to increased resistance to the transmitral flow. Although rheumatic fever remains the predominant cause of mitral stenosis worldwide, other causes are increasingly relevant in the developed countries with degenerative mitral stenosis (DMS) because of mitral annulus calcification (MAC) becoming growingly prevalent in industrialized countries with higher life expectancy. Rheumatic mitral stenosis (RMS) and DMS display dramatic differences in pathophysiology, prognosis, and disease progression. Furthermore, to date, robust evidence regarding the management of DMS because of MAC is lacking. Nevertheless, new diagnostic techniques and catheter-based interventions are changing this landscape and paving the way to a significant reduction in DMS-related morbidity and mortality. Here we briefly review the current knowledge on the pathophysiology, diagnosis and treatment of DMS and RMS, underscoring the current diagnostic and therapeutic pathways, as well as persisting uncertainties and perspectives.

Fluoroscopy versus Transthoracic Echocardiography for Detection of Mitral Valve Calcification in Patients Undergoing Percutaneous Mitral Balloon Valvuloplasty

“…13 Usually, up to adulthood, asymptomatic but untreated complications of MS include atrial arrhythmias, cerebral or peripheral embolism, infective endocarditis, right ventricular failure, and pulmonary hypertension. [2][3][4] Evaluation of Mitral valve calcification is of great importance as it decides the treatment plan for the patient. Valve calcification assessment can be done via echocardiography (TTE) and/or fluoroscopy.…”

“…However, calcifications are much more easily seen with fluoroscopy. 3,4 The two-dimensional echocardiogram can help determine whether MS patient is a good candidate for balloon mitral valvuloplasty or replacement. Valve calcification on radiography is pathognomonic of significant valve disease.…”

Impact of Strict and Lenient Heart Rate Control on Six-Minute Walk Test and Quality of Life in Atrial Fibrillation Patients with Rheumatic Mitral Stenosis: A Preliminary Study

“…6 Heart rate regulation commonly involves the use of β-blocker medications and digitalis as atrioventricular node inhibitors to modulate heart rate in AF patients within the general population. 7 Findings from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trials underscored the superior efficacy of β-blockers over calcium channel blockers in heart rate control, with β-blockers demonstrating a higher rate of effectiveness (70% vs. 54%), whether administered either independently or alongside digitalis. However, the Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison between Lenient versus Strict Rate Control II (RACE II) study revealed no discernible disparity between lenient and strict heart rate control strategies in general AF management.…”

“…Notably, there are currently no established guidelines delineating target heart rates specifically tailored to this patient cohort. 7 This study sought to explore the influence of strict and lenient heart rate control on the functional capacity, assessed via the Six-Minute Walk Test (SMWT), within the special population of individuals afflicted with AF and RMS.…”

Surgical Reconstruction of Mitral Restenosis Complicated by a Critically Small Left Ventricular Cavity and Giant Left and Right Atriomegaly (Clinical Case)

“…Left atriomegaly in the presence of a tachyform AF contributes to the occurrence of blood clots in the LA cavity and gives a high probability of thromboembolic complications. Dilated LA contributes to the progression of cardiorespiratory failure due to compression of the bronchi, trachea and posterior wall of LV [2,3,4,5,6,7].…”