Rheumatic Heart Disease Mitral Valve Stenosis: Treatment Options and Management

Rheumatic heart disease (RHD) is a long-term complication that arises from repeated episodes of acute rheumatic fever. When it affects the mitral valve, it results in a condition known as mitral valve stenosis. This occurs when the immune response triggered by rheumatic fever causes inflammation and damage to the heart valves, particularly the mitral valve, which separates the left atrium and left ventricle.

Understanding Mitral Valve Stenosis in RHD

Over time, chronic inflammation and mechanical stress from turbulent blood flow cause structural changes in the valve. These include swelling, fibrosis, and the formation of abnormal growths on the valve leaflets. As the condition progresses, platelets and fibrin accumulate and undergo degenerative changes, leading to leaflet fusion, thickening, calcification, and shortening or fusion of the chordae tendineae and papillary muscles. This ultimately results in a narrowed valve opening, impairing the normal flow of blood through the heart.

Symptoms and Diagnosis

Patients may experience symptoms such as shortness of breath, fatigue, palpitations, and fluid retention. Diagnosis typically involves a combination of physical examination, echocardiography, electrocardiogram (ECG), and sometimes cardiac catheterization to assess the severity of stenosis and overall heart function.

Treatment Approaches for Mitral Valve Stenosis

The management of mitral valve stenosis due to rheumatic heart disease involves both medical and surgical interventions. The choice of treatment depends on the severity of the condition, the presence of symptoms, and the patient's overall health status.

Medical Therapy

Medications are primarily used to manage symptoms, improve heart function, and stabilize the patient prior to surgery. Commonly prescribed drugs include diuretics to reduce fluid buildup, beta-blockers or calcium channel blockers to control heart rate, and anticoagulants to prevent blood clots, especially in patients with atrial fibrillation. These therapies help improve quality of life and delay disease progression.

Surgical Interventions

When stenosis becomes severe or symptoms are not adequately controlled with medications, surgical treatment is recommended. The two main procedures are mitral valve replacement and mitral valve repair (valvuloplasty). Valve repair is often preferred when feasible, as it preserves the natural valve structure and may lead to better long-term outcomes. However, in cases of extensive valve damage, replacement with a mechanical or biological prosthetic valve is necessary.

Importance of Early Intervention

Timely diagnosis and appropriate treatment play a crucial role in improving prognosis. Early surgical intervention, in particular, can significantly slow the progression of the disease, reduce symptoms, and enhance life expectancy. Regular follow-up and monitoring are essential to manage complications and ensure optimal heart function over time.