Mitral Stenosis

Definition:  A narowing of the MV, impeding diastolic flow of blood from the LA into the LV. A high pressure jet can be visualized in the LV due to the valve narrowing.

Causes (Etiology):
- Rheumatic fever (99%, most common)
- Congenital
- Severe Mitral Annular Calcification
- L. Atrial Tumor
- L. Atrial Ball-Valve Thrombus

Patient History:
- Dyspnea Upon Exertion (80%)
- Hemoptysis
- Chest Pain
- Palpitations
- Syncope

- Thickened MV leaflets
- Decreased E-F slope of the AMVL
- Anterior motion of the PMVL

- Thickened MV leaflets (> 3mm), especially at the leaflet tips and chordae along with restricted valve motion.
- Diastolic "doming" of the AMVL ("hockey-stick appearance") Best observed in PLAX.
- Shortening and Fibrosis of Chordae Tendineae.
- Commisural Fusion. Best observed in PSAX of the MV.
- L. Atrial Dilatation, L. Atrial Spontaneous Echo Contrat ("smoke"), and LA thrombus, usually present in the atrial appendage.

In PW & CW Doppler:
- Increased Mitral Valve E velocity recorded at the MV leaflet tips (> 1.3 m/s)
- Decreased E-F slope of the MV inflow doppler tracing
- Evaluate the pulmonary venous flow pattern
- Determine:
    + P1/2T
    + MVA by P1/2T
    + MVA by the continuity equation

Color Flow Doppler:
- Narrow "flame-shaped" turbulent (mosaic) jet at MV leaflet tips which extends into the LV in diastole.
- Determine:
    + MVA qualitatively by examining how narrow the color flow jet is at the MV leaflet tips (aka the "vena contracta")
    + MVA by the PISA method

Additional Notes:
- Mitral Stenosis is a pressure overload of the LA, pulmonary vascular tree, and RV.
- Mitral stenosis affects females in a ratio of 3:1