Treatment Options for Mitral Valve Stenosis Caused by Rheumatic Heart Disease

Rheumatic heart disease is a progressive condition that can lead to complications such as mitral valve stenosis. In the early stages, when the condition is mild and the valve structure remains relatively healthy, patients may only experience minor symptoms. In such cases, the valve leaflets are often still pliable, with fusion limited to the commissural areas. Previously, a technique known as closed surgical valvotomy was used to widen the valve opening. However, this method has largely been replaced by balloon valvuloplasty, a less invasive procedure that uses a catheter-guided balloon to separate the fused leaflets and restore proper blood flow.

When Is Surgical Intervention Necessary?

As the disease progresses, the valve may become increasingly fibrotic, calcified, and rigid. At this stage, interventional procedures may no longer be effective, and surgical treatment becomes necessary. There are two primary surgical approaches for managing advanced mitral stenosis:

1. Mitral Valve Repair (Valvuloplasty)

Valve repair is often the preferred option when feasible. Advances in surgical techniques have significantly improved the success rates of mitral valve reconstruction. This procedure aims to restore the natural function of the valve by removing calcium deposits, separating fused leaflets, and reshaping the valve structure. The advantage of repair is that it preserves the patient's own valve, avoiding the need for long-term anticoagulation therapy that is typically required with mechanical replacements.

2. Mitral Valve Replacement

If the valve is too damaged to be repaired effectively, valve replacement surgery may be recommended. During this procedure, the diseased mitral valve is removed and replaced with either a mechanical valve or a bioprosthetic (tissue) valve. Mechanical valves are durable but require lifelong blood-thinning medication to prevent clotting. On the other hand, bioprosthetic valves do not usually require extended anticoagulation, but they may wear out over time and need replacement, especially in younger patients.

Choosing the Right Treatment Approach

The choice between repair and replacement depends on several factors, including the severity of stenosis, the condition of the valve tissue, the patient's age, overall health, and lifestyle. A thorough evaluation by a cardiologist and cardiac surgeon is essential to determine the most appropriate treatment plan tailored to each individual case.