This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Carabello, B. A. Search for Related Content PubMed PubMed Citation Articles by Carabello, B. A. Related Collections Valvular heart disease Catheter-based coronary and valvular interventions: other CV surgery: valvular disease

(Circulation. 2005;112:432-437.)
© 2005 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Modern Management of Mitral Stenosis

Blase A. Carabello, MD

From Baylor College of Medicine, Department of Medicine and the Veterans Affairs Medical Center, Houston, Tex.

Correspondence to Blase A. Carabello, MD, Baylor College of Medicine, Department of Medicine and the Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030. E-mail blaseanthony.Carabello@med.va.gov

Key Words: mitral valve stenosis • disease management • heart valve diseases

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Although once rheumatic fever and its consequences were the major cause of valvular heart disease in the developed world, this disease has become exceedingly rare today. As a consequence, mitral stenosis (MS), which is usually caused by rheumatic fever, has also become rare. In fact, MS is most commonly found in the United States in patients who have emigrated here from areas where rheumatic fever is still endemic. Nonetheless, 1500 balloon mitral valvotomies (BMVs) were performed in the United States last year, which provides a rough index of severe disease prevalence. The following is a review of the current understanding and management of this disease.

	Etiology

 
Although the attack rate for rheumatic fever is roughly equal among genders, MS is 2 to 3 times more common in women. It is generally believed that the M protein antigen held in common between the heart and group A hemolytic Streptococcus results in an autoimmune attack of the heart in response to streptococcal infection.^1–3 What factors cause susceptibility to the illness remain unclear. Likewise, factors responsible for the decline in MS incidence in developed countries are also obscure. Although the decline may be due in part to the introduction of antibiotics, a fall in the attack rate of rheumatic fever began well before antibiotics were widely available.⁴

Once begun, the rheumatic process leads to inflammation in all 3 layers of the heart: endocardium, myocardium, and pericardium. However, the disease primarily affects the endocardium, leading to inflammation and scarring of the cardiac valves. Although the . . . [Full Text of this Article]

This article has been cited by other articles:

				K Guha, S Piper, and P D Collins Progressive shortness of breath BMJ, January 14, 2009; 338(jan14_3): a3095 - a3095. [Full Text]

				M. R. Akram, T. Chan, S. McAuliffe, and A. Chenzbraun Non-rheumatic annular mitral stenosis: prevalence and characteristics Eur J Echocardiogr, January 1, 2009; 10(1): 103 - 105. [Abstract] [Full Text] [PDF]

				D. N. Salem, P. T. O'Gara, C. Madias, and S. G. Pauker Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 593S - 629S. [Abstract] [Full Text] [PDF]

				A. J. Mittnacht, M. Fanshawe, and S. Konstadt Anesthetic Considerations in the Patient With Valvular Heart Disease Undergoing Noncardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2008; 12(1): 33 - 59. [Abstract] [PDF]

				N U Weir An update on cardioembolic stroke Postgrad. Med. J., March 1, 2008; 84(989): 133 - 142. [Abstract] [Full Text] [PDF]

				P. J. Peters, D. Goldglantz, M. Sadler, J. Schuck, M. Weiss, and D. Tarditi Percutaneous Balloon Mitral Valvuloplasty During Pregnancy Journal of Diagnostic Medical Sonography, March 1, 2006; 22(2): 117 - 122. [Abstract] [PDF]