Medical treatment and intervention for mitral stenosis
THE CONTEXT
Management depends on symptoms, pulmonary hypertension and valve characteristics, with continued surveillance after valvuloplasty or valvotomy.
Medical management
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Patients with mild symptoms can be treated medically.
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Anticoagulation reduces the risk of systemic embolism.
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Digoxin, β-blockers or rate-limiting calcium antagonists provide ventricular rate control in atrial fibrillation.
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Diuretics control pulmonary congestion.
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Atrial fibrillation in rheumatic mitral stenosis requires a vitamin K antagonist rather than a direct oral anticoagulant.
When to consider intervention
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Consider balloon valvuloplasty, mitral valvotomy or mitral valve replacement if symptoms persist despite medical treatment or pulmonary hypertension develops.
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Valvuloplasty is the treatment of choice when specific selection criteria are fulfilled; surgical closed or open mitral valvotomy is an acceptable alternative.
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Valve replacement is indicated for substantial mitral reflux or a rigid, calcified valve.
Follow-up after valvuloplasty or valvotomy
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Follow patients at intervals of 1–2 years because restenosis may occur.
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Symptoms and signs guide assessment of restenosis severity, but Doppler echocardiography provides a more accurate assessment.