Treating mitral valve stenosis when complications exist
How to treat mitral valve stenosis when certain complications are present is controversial.
Atrial fibrillation
Atrial fibrillation is a serious medical condition and will need to be treated along with your mitral valve stenosis. However, debate exists within the medical community about how to best treat your mitral valve stenosis if atrial fibrillation is the only symptom you are experiencing.
One theory holds that by fixing the valve before you have had atrial fibrillation for a long period of time, you should be able to keep the atrial fibrillation from becoming permanent, because the longer you have atrial fibrillation, the more unlikely it is to go away. While this is logical, there is currently no long-term clinical study that proves that this approach eliminates or reduces the occurrence of atrial fibrillation. Therefore, many doctors are now suggesting that when you have surgery to correct your mitral valve that you also have a procedure that disrupts some of the electrical pathways on the surface of your heart that are causing the atrial fibrillation.
In this procedure, small incisions are made on the inside surface of the upper heart chamber. Scar tissue forms, which does not conduct electrical activity and thereby prevents erratic electrical signals from occurring. Strategically placed incisions may be made to form a specific channel in an attempt to direct electric signals through a controlled path to the lower heart chambers.
Pulmonary hypertension
There is some debate about whether you should undergo mitral valve replacement if you have severe mitral stenosis with severe pulmonary hypertension, but no or mild symptoms. The combination of the two conditions places a great deal of strain on the right ventricle and may cause it to fail, and replacing the valve may prevent right ventricular failure. However, guidelines for treating mitral valve stenosis generally recommend waiting until severe symptoms are present before replacing the mitral valve. If you find yourself in this situation—and it should be stressed that it is uncommon for severe pulmonary hypertension to be asymptomatic—you and your doctor should consider all aspects of your health before deciding to replace the valve.
| Author: | Robin Parks, MS | Last Updated: March 18, 2008 |
| Medical Review: | E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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