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Rheumatic mitral stenosis has the following features:

  • commissures adherent, leaving small, central, oval orifice
  • cusps fibrous and thickened
  • chordae tendinae shortened and thickened

Ventricular filling is impaired when the valve area is reduced to 2.5 square centimetres. Progressive fibrotic thickening and rigidity of cusps results in the development of significant stenosis (valve area less than 1.5 square centimetres) by the age of 30-40 years. This process occurs earlier (15-20 years) in India and the Middle East.

Non-rheumatic causes of mitral stenosis are rare, these include:

  • congenital malformation
  • Libman-Sachs endocarditis
  • the obstructive vegetations of infective endocarditis
  • calcified mitral valve ring

Last reviewed 01/2018