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​Mitral Valve Stenosis

Mitral valve stenosis, or mitral stenosis, is a narrowing of the heart's mitral valve — a one-way valve that opens and closes to control the flow of blood through your heart.

The UPMC Heart and Vascular Institute's Center for Mitral Valve Disease is a leader in diagnosing and treating mitral valve stenosis, as well as researching the latest treatments.

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What is Mitral Valve Stenosis?

The mitral valve is located between the heart's left upper chamber (the left atrium) and the heart's lower left chamber (the left ventricle). It opens to allow blood to move out of the atrium and into the ventricle and and then closes to prevent blood from moving in the wrong direction.

When a heart with a healthy mitral valve squeezes, it sends blood from the atrium to the empty left ventricle.

The mitral valve's two flaps — or leaflets — open to allow blood to pass through. When the heart relaxes and the ventricle fills with blood, the flaps close.

Mitral valve stenosis prevents your mitral valve from opening properly, in some cases by causing the two flaps to partially fuse together. This prevents some of the blood from moving out of the atrium.

Causes of mitral valve stenosis

Calcification of the mitral valve commonly causes mitral valve stenosis. As you age, calcium can build up around the valve, leading to a variety of complications.

Mitral valve stenosis can also result from rheumatic fever, a childhood illness that occurs alongside conditions like strep throat or scarlet fever. Complications from these illnesses can damage the mitral valve or even cause it to fuse, though symptoms may not appear until years later. Although extremely rare in the United States due to effective antibiotics, rheumatic fever is still the second leading cause of mitral valve stenosis.

Other causes of mitral stenosis include:

  • Prior external radiation to the chest cavity during cancer treatment.
  • Prior known history of congenital, or birth-related, abnormalities.
  • Some rare medications.

Mitral valve stenosis complications

Without treatment, mitral valve stenosis can lead to:

  • Heart failure — a condition in which your heart cannot pump enough blood to meet your body's needs
  • Heart enlargement
  • Atrial fibrillation
  • Blood clots (atrial fibrillation increases the risk of developing blood clots)
  • Fluid build-up in the lungs

Why choose UPMC's Center for Mitral Valve Disease for mitral stenosis care?

At the UPMC Heart and Vascular Institute's Center for Mitral Valve Disease, our multidisciplinary team of cardiac surgeons, interventional cardiologists, cardiologists, anesthesiologists, and nurses works together to:

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Mitral Valve Stenosis Symptoms and Diagnosis

Mitral valve stenosis symptoms

Many people with mitral valve stenosis have no symptoms at all. When symptoms do occur, they usually begin gradually in people in their 30s or 40s, though they can occur at any age.

Symptoms of mitral valve stenosis can appear suddenly and worsen when your heart beat rises, like during exercise or physical exertion. Pregnancy and infection can also bring about symptoms. Telltale signs include heart murmur and irregular heart rhythms, or arrhythmias.

Other people with the condition may have mild symptoms that worsen over time, including:

  • Fatigue, especially when exercising
  • Shortness of breath during mild exertion or even at rest or when you lie down
  • Swollen feet or ankles (edema)
  • Heart palpitations, which is the sensation of feeling your own heartbeat
  • Frequent lung infections, such as bronchitis
  • Coughing, sometimes with blood

Diagnosing mitral valve stenosis

In addition to asking about your medical history, your doctor at the UPMC Heart and Vascular Institute's Center for Mitral Valve Disease will perform a physical exam.

Mitral stenosis often causes murmurs, or abnormal sounds of blood flowing through your heart.

Tests your doctor may use to diagnose mitral valve stenosis include:

  • Echocardiogram, which uses sound waves to create images of your heart and valves.
  • Electrocardiogram, which measures your heart's electrical activity.
  • Chest x-ray to see the size and shape of your heart.
  • Cardiac catheterization, which enables your doctor to see blood flow through the heart and its arteries.
  • Magnetic resonance imaging (MRI) scan, which uses a magnetic field and radio waves to create images of your heart. 

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Mitral Valve Stenosis Treatment

At the UPMC Heart and Vascular Institute's Center for Mitral Valve Disease, we take a team approach to diagnose and treat mitral valve stenosis.

Treatment goals for mitral valve stenosis are to treat symptoms of heart failure with medication. In addition, your UPMC doctor may recommend repairing or replacing the valve, either minimally invasively or surgically.

Balloon valvuloplasty for mitral valve stenosis

Balloon valvuloplasty is a minimally invasive procedure in which an interventional cardiologist inserts a catheter into a small blood vessel through a tiny incision in your groin.

The cardiologist guides the catheter through your blood vessels to the mitral valve. The catheter has a small balloon at its tip, which the interventional cardiologist inflates and deflates.

Inflating the balloon forces the fused portion of the leaflets to separate. This helps the valve to open more fully and allow more blood to pass through with each heart beat.

Minimally invasive valve repair

In severe cases of mitral stenosis — if the mitral valve is not amenable to balloon valvuloplasty — doctors recommend surgery.

The surgeon will evaluate the valve and determine if it can be surgically repaired.

Surgical valve replacement for mitral stenosis

Your surgeon may recommend valve replacement surgery if your mitral valves cannot be repaired.

Once your surgeon has removed your mitral valve, he or she will replace it with a mechanical or tissue valve.

  • Mechanical valves last for a long time, but they can cause blood clots. People who have mechanical valves will need to take blood-thinning medication, such as warfarin (Coumadin®), to prevent clotting.
  • Tissue valves do not cause clots, but they do not last as long as mechanical valves and will eventually need to be replaced after 10 or more years. 

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Mitral Valve Stenosis Educational Materials

The UPMC Heart and Vascular Institute offers educational information and videos about mitral valve stenosis and other heart and vascular diseases and treatments.

Many people find these resources helpful in answering their questions about their heart valve condition and preparing them for their procedure or diagnostic test.

UPMC Heart and Vascular Institute

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