treatment

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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.

  • anticoagulation:
    • 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.

Reference:

  1. NICE (November 2021). Heart valve disease presenting in adults: investigation and management

Last edited 11/2021

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