From the Guidelines
Rheumatic heart disease is the most common cause of mitral stenosis, accounting for the majority of cases worldwide, as it leads to scarring and fusion of the mitral valve leaflets, causing progressive narrowing of the valve opening 1. The pathophysiology of mitral stenosis involves restricted blood flow from the left atrium to the left ventricle, resulting in increased left atrial pressure, pulmonary hypertension, and eventually right heart failure if left untreated. Some key points about the causes of mitral stenosis include:
- Rheumatic heart disease is the predominant cause of mitral stenosis, with a history of rheumatic fever present in approximately 60% of patients with pure mitral stenosis 1
- Other less common causes include congenital mitral stenosis, calcific degeneration of the mitral valve, infective endocarditis, systemic lupus erythematosus, and rheumatoid arthritis 1
- The ratio of women to men presenting with isolated mitral stenosis is 2:1, and isolated mitral stenosis occurs in 40% of all patients presenting with rheumatic heart disease 1
- Acquired causes of mitral valve obstruction, other than rheumatic heart disease, are rare, and include left atrial myxoma, ball valve thrombus, mucopolysaccharidosis, and severe annular calcification 1.
From the Research
Causes of Mitral Stenosis
- The most common cause of mitral stenosis is rheumatic fever, which is the result of acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection 2
- Rheumatic fever is the most common cause of acquired heart disease in children and young adults worldwide, mainly in developing countries, and is the reason that a large number of patients with mitral stenosis will require some modality of treatment during their life span 3
- Rheumatic mitral valve stenosis is a major etiology for mitral stenosis (MS) 2
Prevalence of Rheumatic Mitral Stenosis
- The incidence of acute RF in the Western world had substantially declined over the past five decades, but this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher 2
- Atrial fibrillation (AF) is frequent in patients with rheumatic mitral stenosis (MS) 4