The management of a patient with mitral stenosis includes the following:
- prevention of recurrent rheumatic fever:
- penicillin is given for 5 years after the last attack of rheumatic fever or until the age of 20.
- this is to prevent thrombo-embolism.
- some say should be started before the onset of atrial fibrillation.
- consider a beta-blocker for adults with moderate to severe mitral stenosis and heart failure (1)
- diuretics - lessen pulmonary venous pressure.
- balloon valvuloplasty:
- best results are obtained when the valve shows commissural fusion, is pliable, is not heavily calcified, and has little or no disease of the subvalvular apparatus
- surgical mitral valvotomy or valve replacement
NICE state (1):
- consider transcatheter valvotomy for adults with rheumatic severe* mitral stenosis, if the valve is suitable for this procedure
- offer surgical mitral valve replacement to adults with rheumatic severe* mitral stenosis if transcatheter valvotomy is unsuitable
* severity of valve disease is defined in line with the British Society of Echocardiography guidelines on the British Heart Foundation's website.
Last edited 11/2021