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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.


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

Last edited 11/2021