Mitral Stenosis—Child
En Español (Spanish Version)

Definition
Mitral stenosis is a narrowing of the mitral valve in the heart. The mitral valve is in the left side of the heart between the upper and lower chambers of the heart. When working properly, the valve helps to keep blood flowing in the right direction from the upper to the lower chambers.

Mitral stenosis makes it difficult for blood to move from the upper and lower chambers. This means there is less blood for the lower chamber to pump out to the body. The blood can also back up in the upper chamber and push back into the lungs.

Mitral Valve Stenosis

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Causes
The most common cause of mitral stenosis is rheumatic fever . This infection that may develop after strep throat or scarlet fever and can scar the heart valves. Mitral stenosis may develop 5-10 years after this infection occurs.

Less common or very rare causes include:

  • Birth defect
  • Blood clots
  • Tumors
  • Infective endocarditis
  • Other growths that block blood flow through the mitral valve
Risk Factors
The main risk factor for mitral stenosis is rheumatic fever. Other risk factors may include:

  • Being born with mitral valve problems
  • Having other health problems that affect blood flow in the heart
Symptoms
Symptoms are caused by the problems with blood flow and may include:

  • Hard time breathing, especially during exercise and when lying flat
  • Waking up short of breath in the middle of the night
  • Tiredness
  • Sensation of rapid or irregular heartbeat
  • Cough with exertion
  • Coughing up blood
  • Swelling of the legs or feet
  • Frequent respiratory infections
  • Dizziness, fainting
  • Chest pain, like squeezing, pressure, or tightness (rare)
Diagnosis
The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. The doctor may suspect mitral stenosis from:

  • Abnormal chest sounds, such as a heart murmur or snap
  • Stretching of a vein in the neck
  • Signs of fluid in the lungs
The diagnosis will be made after observing the mitral valve itself. Images of the heart and its structures may be taken during:

The heart's abilities may also be tested with:

  • Electrocardiogram (ECG, EKG)—a record of the electrical activity of the heart
  • Stress test —test how the body responds to physical exertion
Treatment
If your child has mild mitral stenosis, immediate treatment may not be needed. Your doctor will monitor your child's condition to look for potential problems. Other treatment options include:

Medications
Certain medication may be given to improve heart function. The medications may help control the heart's rhythm and prevent the build up of fluid in the body.

Antibiotics may be needed to treat certain infections.

Surgery
Your child may need surgery to prevent heart damage. Common types of heart valve surgery include:

  • Mitral valvulotomy—A surgical cut is made in the stenotic mitral valve to allow the valve to open wider.
  • Balloon valvuloplasty —A balloon is inflated in the valve to stretch out the surrounding tissue. This may provide temporary relief of symptoms but the valve may become blocked again.
  • Mitral valve replacement—the valve is replaced with a mechanical or tissue valve
Complication Management
There are several steps your child can take to avoid some of the complications of mitral stenosis:

  • Get regular medical care. This includes basic checkups and heart tests.
  • Take antibiotics before any dental cleaning, dental work, or other invasive procedures if it is recommended by your doctor. Not all patients with mitral stenosis need antibiotics for these procedures.
  • Eat a healthy diet that is low in salt. Work with the doctor or dietician to plan a healthy diet for your child. This may help decrease the pressure in your child’s heart and improve symptoms.
  • Monitor blood pressure. Inform the doctor if your child seems to be developing high blood pressure .
Follow the doctor's instructions if your child is diagnosed with mitral stenosis.

Prevention
Most cases of mitral stenosis can be prevented by preventing rheumatic fever:

  • Treat strep throat infections right away to avoid rheumatic fever, which can cause scarring of the heart valve.
  • Always make sure your child finishes all of the antibiotics given, even if he feels better.



RESOURCES:
American Heart Association

National Heart, Lung, and Blood Institute

CANADIAN RESOURCES:
Canadian Cardiovascular Society

Canadian Family Physician

References:
Mitral stenosis. DynaMed website. Available at: http://www.dynamicmedical.com/dynamed.nsf. Updated November 16, 2013. Accessed June 20, 2013.

Seattle Children’s Hospital. Mitral valve abnormalities. Seattle Children’s Hospital website. Available at: http://www.seattlechildrens.org/medical-conditions/heart-blood-conditions/mitral-valve-abnormalities-symptoms/. Accessed June 20, 2013.

Shipton B, Wahba H. Valvular heart disease: review and update. Am Fam Physician . 20011;63:2201.

Last Reviewed December 2013



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