THE CONTEXT
Progressive fibrosis alters valve structure and function, while the resulting haemodynamic stresses can sustain further damage.
Structural changes and valve dysfunction
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The heart valves become affected by progressive fibrosis.
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Fusion of the mitral commissures and shortening of the chordae tendineae may cause mitral stenosis with or without regurgitation.
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Similar changes in the aortic and tricuspid valves distort and stiffen the cusps, producing stenosis and regurgitation.
Progression after initial damage
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Once a valve is damaged, altered haemodynamic stresses perpetuate and extend the damage.
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Progression can continue even in the absence of an ongoing rheumatic process.