Most useful noninvasive test; shows reduced separation, calcification and thickening of valve leaflets and subvalvular apparatus, and LA enlargement. Doppler flow recordings provide estimation of transvalvular gradient, mitral valve area, and degree of pulmonary hypertension (Chap. 112. Noninvasive Examination of the Heart).
Treatment: Mitral Stenosis At-risk pts should receive prophylaxis for recurrent rheumatic fever (penicillin V 250-500 mg PO bid or benzathine penicillin G 1-2 M units IM monthly) (See Fig. 114-1). In the presence of dyspnea, sodium restriction and oral diuretic therapy; beta blockers, rate-limiting calcium channel antagonists (i.e., verapamil or diltiazem), or digoxin to slow ventricular rate in AF. Warfarin (with target INR 2.0-3.0) for pts with AF or history of thromoembolism. For AF of recent onset, consider conversion (chemical or electrical) to sinus rhythm, ideally after ≥3 weeks of anticoagulation. Mitral valvotomy in the presence of symptoms and mitral orifice ≤ ~1.5 cm2. In uncomplicated MS, percutaneous balloon valvuloplasty is the procedure of choice; if not feasible, then open surgical valvotomy (Fig. 114-1). |