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Treatments and drugs
By Mayo Clinic staffTreatments to prevent permanent damage to your heart from mitral valve stenosis include medications and invasive procedures.
Invasive treatment for mitral valve stenosis isn't always needed right away. If tests reveal that you have mild to moderate mitral valve stenosis and you have no symptoms, there's generally no need for immediate valve repair or replacement. Instead, your doctor will schedule checkups to carefully monitor the valve so that surgery can be done as soon as your condition becomes severe. Some people never need anything done to the mitral valve because they never develop severe mitral valve stenosis.
Medications
No medications can correct a defect in the mitral valve. However, certain drugs can reduce symptoms by easing your heart's workload and regulating your heart's rhythm.
For example, your doctor may prescribe:
- Diuretics. These drugs can reduce fluid accumulation in your lungs or elsewhere.
- Blood thinners (anticoagulants). These medications help to prevent blood clots from forming.
- Antibiotics. Your doctor may recommend antibiotics before certain dental or medical procedures to reduce the risk of bacteria entering your bloodstream and causing an infection in your heart (endocarditis).
Your doctor may also prescribe drugs to treat atrial fibrillation or other rhythm disturbances associated with mitral valve stenosis.
Procedures
You may need valve repair or replacement to treat mitral valve stenosis. Both surgical and nonsurgical options are available.
Repair with balloon valvuloplasty (valvotomy)
This nonsurgical procedure uses a soft, thin tube (catheter) tipped with a balloon. A doctor guides the catheter through a blood vessel in your arm or groin to your heart and into your narrowed mitral valve. Once in position, a balloon at the tip of the catheter is inflated. The balloon pushes open the mitral valve and stretches the valve opening, improving blood flow. The balloon is then deflated and the catheter with balloon is guided back out of your body. Balloon valvuloplasty can relieve mitral valve stenosis and its symptoms. But it may not be appropriate if the valve is both tight (stenotic) and leaky (regurgitant). It's also not performed if there's a blood clot in a chamber of your heart, because of the risk of dislodging it. You may need the procedure repeated within 10 years.
Mitral valve surgery
If there is more than mild leakage (regurgitation) of your valve or if you have other valve problems in addition to mitral stenosis, surgery may be a better option than balloon valvuloplasty. Surgical options include:
- Valvuloplasty. Using traditional surgical tools, a cardiac surgeon may make repairs such as separating fused valve leaflets and removing obstructions on or near the mitral valve. This helps clear the valve passageway. You may need the procedure repeated if you develop mitral valve stenosis again in the years following surgery.
- Mitral valve replacement. Most people with mitral valve stenosis who need surgery will have mitral valve replacement. Your surgeon removes the narrowed mitral valve and replaces it with a mechanical valve or a tissue valve. Mechanical valves, made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical mitral valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves — which may come from a pig, cow or human cadaver donor — often need to be replaced. Your doctor can discuss the risks and benefits of each type of heart valve with you.
Mitral valve surgery may involve open-heart surgery. However, techniques that use less invasive techniques are increasingly available. For example, in robotic surgery, a surgeon watches a 3-D image of the area being operated on and uses hand controls that tell thin robotic arms how to maneuver surgical tools. This approach uses smaller incisions, and recovery time is faster in most cases.
You may continue to be at risk of arrhythmias even after successful surgery for mitral valve stenosis. You may need to take medications to lower that risk.
Other procedures
In some cases your surgeon may perform additional surgery at the time of your operation to try to keep your heart in normal rhythm, such as the maze procedure. This involves making a series of surgical incisions in the upper half of your heart (atria). These heal into carefully placed scars in the atria that form boundaries that force electrical impulses in your heart to travel properly to cause the heart to beat efficiently.
- Otto CM. Pathophysiology and clinical features of mitral stenosis. http://www.uptodate.com/home/index.html. Accessed July 3, 2009.
- Carabello BA. Valvular heart disease. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/148441160-6/860446560/1492/318.html#4-u1.0-B978-1-4160-2805-5..50080-X_3105. Accessed July 3, 2009.
- Ferri FF. Mitral stenosis. In: Ferri FF. Ferri's Clinical Advisor 2009. St. Louis, Mo.: Mosby; 2008. http://www.mdconsult.com/das/book/body/148441160-8/860527324/1701/373.html#4-u1.0-B978-0-323-04134-8..50016-1--cesec452_7951. Accessed July 3, 2009.
- Mitral stenosis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec07/ch076/ch076f.html. Accessed July 3, 2009.
- Sorrentino MJ. Medical management and indications for intervention in mitral stenosis. http://www.uptodate.com/home/index.html. Accessed July 3, 2009.
- Sorrentino MJ. Surgical management of mitral stenosis. http://www.uptodate.com/home/index.html. Accessed July 3, 2009.
- Am I at risk of developing arrhythmias? American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=562. Accessed July 3, 2009.
- Ardehali R, et al. Valvular heart disease. In: Nilsson KR, et al. The Osler Medical Handbook. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/148441160-4/860446560/1387/28.html#4-u1.0-B0-323-03748-8..50017-8_181. Accessed July 3, 2009.
- Living with arrhythmia. American Heart Association. http://www.nhlbi.nih.gov/health/dci/Diseases/arr/arr_livingwith.html. Accessed July 3, 2009.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. July 19, 2009.
