Treatment for rheumatic mitral stenosis depends on damage

Dear Doctors: At age 51, I was diagnosed with severe rheumatic mitral stenosis. After a second round of tests, treatment was changed from open-heart surgery to balloon valvuloplasty. What can I do to help the results last? Should open-heart surgery be considered instead?

Dear Reader: Heart valves can have structural problems that affect their function. Stenosis, or narrowing, is one of these problems. In your case, the stenosis is in your mitral valve. This valve separates the left atrium (upper left chamber) of the heart from the left ventricle (lower left chamber). When rheumatic fever causes valve dysfunction, as in your case, it’s called rheumatic mitral stenosis.

This narrowing of the valve impedes the flow of blood into the left ventricle. It forces the heart muscle to work harder and causes pressure to build upstream. This can lead to an enlarged left atrium, heart arrhythmia, high blood pressure in the lungs and heart failure. A decrease in blood flow can cause symptoms such as fatigue, dizziness and fainting. More serious symptoms include systemic fluid buildup known as edema, frequent respiratory infections, coughing up blood and the formation of blood clots, which can cause a stroke.

Treatment depends on the degree of damage to the mitral valve. If it is thin, flexible, with little scarring and minimal backflow of blood, valvuloplasty can be an option. Valvuloplasty is a catheter repair usually done by a cardiologist. They insert a thin tube into the heart through a vein, typically through the groin. Then they insert a tiny balloon through the tube. They inflate the balloon slowly to stretch and expand the mitral valve. If the valve leaflets are too thick or have fused together, the valve may need replacing. This requires open-heart surgery. Rheumatic mitral stenosis often causes this degree of valve damage.

To determine the best path forward, you need to work with a cardiologist. They will review the tests you had and can understand why your recommended treatment may have changed. They’ll likely order additional testing. If imaging tests confirm the mitral valve is in good condition, the minimally invasive catheter repair may be the best approach.

Whichever treatment path you follow, there are a few things you can do to make the repair last as long as possible. Take all prescribed medications exactly as directed, keep blood pressure under control and regularly follow up with your cardiologist. Treat infections such as strep promptly, prevent recurrent infections and maintain good dental hygiene. These steps will all help give your heart the best chance at longevity.

Send your questions to askthedoctors@mednet.ucla.edu.