Mitral stenosis

Mitral stenosis refers to stenosis of the mitral valve in the heart.

It is characterised by restriction of blood flow from the left atrium to the left ventricle as a result of a narrowed mitral passage. Mitral stenosis is usually an acquired valvular defect and historically, the commonest cause has been rheumatic heart disease. However, cases of congenital mitral stenosis are occasionally encountered.

A widely adopted echocardiographic scoring system that Wilkins and colleagues developed helps in patient selection. In this system, 4 features of the mitral valve are identified, as follows:

  • valve leaflet mobility
  • valve thickening
  • valve calcification
  • sub-valvular involvement

Chest radiographs may show:

  • cardiomegaly
  • double right heart border (enlarged left atrium and normal right atrium)
  • prominent left atrial appendage
  • splaying of the subcarinal angle (>120 degrees)

Non-rheumatic causes of mitral stenosis usually produce nonspecific imaging features such as valve thickening or leaflet fixation.

Associated features include:

Restricted opening of the thickened valve from commissural fusion (especially with rheumatic valve disease), valve calcification, or both results in a “fish-mouth” appearance on short-axis images. Bowing of a thickened and fibrotic anterior leaflet during diastole may result in a “hockey-stick” appearance which is best seen on two- or four-chamber images 1.

May contribute to the non-invasive assessment of mitral stenosis 6.

Observable features include:

  • mitral leaflet thickening
  • reduced diastolic opening
  • abnormal valve motion toward the left ventricular outflow tract

Velocity-encoded cine-magnetic resonance imaging (VEC-MRI) is a new method for quantitation of blood flow with the potential to measure high-velocity jets across stenotic valves 5-7.

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Article information

rID: 18253
System: Cardiac
Synonyms or Alternate Spellings:
  • Mitral valve stenosis
  • Stenosis of the mitral valve
  • Stenosis of mitral valve
  • Stenotic mitral valve

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