Zwężenie mitralne – Etiologia i przyczyny

Zwężenie mitralne
Etiologia i przyczyny

Zwężenie mitralne (stenoza mitralna) jest chorobą zastawkową serca, w której dochodzi do ograniczenia przepływu krwi z lewego przedsionka do lewej komory, co skutkuje wzrostem ciśnienia w lewym przedsionku (np. z ~10 mmHg do 25 mmHg), naczyniach płucnych oraz prawej stronie serca. Najczęstszą przyczyną jest gorączka reumatyczna, odpowiadająca za około 85% przypadków, charakteryzująca się zrośnięciem spoideł zastawki mitralnej, pogrubieniem i unieruchomieniem płatków oraz zmianami w strunach ścięgnistych. Objawy kliniczne pojawiają się zwykle po 5-15 latach od epizodu gorączki reumatycznej, najczęściej u pacjentów około 50. roku życia. Drugą pod względem częstości etiologią jest zwapnienie pierścieniowo-mitralne (MAC), stanowiące 12-12,5% przypadków, gdzie kalcyfikacja ogranicza rozkurczowe poszerzanie pierścienia i ruchomość płatków, bez zrośnięcia spoideł, co wpływa na odmienne podejście terapeutyczne (np. brak korzyści z komisurotomii balonowej). Rzadkie przyczyny to wrodzone wady zastawki (0,6%), popromienne uszkodzenia, choroby autoimmunologiczne, metaboliczne oraz infekcyjne zapalenie wsierdzia.

Etiologia zwężenia mitralnego

Zwężenie mitralne (stenoza mitralna) to choroba zastawkowa serca charakteryzująca się zwężeniem zastawki dwudzielnej, co prowadzi do ograniczenia przepływu krwi z lewego przedsionka do lewej komory serca. To zaburzenie hemodynamiczne prowadzi do wzrostu ciśnienia w lewym przedsionku, naczyniach płucnych oraz prawej stronie serca.¹²³

Gorączka reumatyczna jako główna przyczyna

Najczęstszą przyczyną zwężenia mitralnego jest gorączka reumatyczna, będąca powikłaniem nieleczonego zakażenia paciorkowcowego, najczęściej anginy paciorkowcowej.⁴⁵ Gorączka reumatyczna odpowiada za około 85% przypadków stenoz mitralnych na świecie.⁶⁷ W przebiegu tej choroby dochodzi do reakcji autoimmunologicznej, w której przeciwciała przeciwko antygenom paciorkowcowym reagują krzyżowo z tkanką zastawki serca, powodując jej uszkodzenie.⁸

Charakterystyczne zmiany w zastawce mitralnej spowodowane gorączką reumatyczną obejmują:⁹¹⁰

Zrośnięcie spoideł zastawki mitralnej
Pogrubienie i unieruchomienie płatków zastawki
Pogrubienie, skrócenie, zrośnięcie i zwapnienie strun ścięgnistych

¹¹

Historia gorączki reumatycznej występuje u 50-70% pacjentów ze zwężeniem mitralnym.¹² Warto zauważyć, że objawy zwężenia mitralnego pojawiają się zwykle dopiero po kilku lub nawet kilkudziesięciu latach od epizodu gorączki reumatycznej.¹³¹⁴ Stenoza mitralna związana z gorączką reumatyczną jest rozpoznawana najczęściej u osób w wieku około 50 lat.¹⁵

W krajach rozwiniętych częstość występowania gorączki reumatycznej znacząco spadła dzięki powszechnemu stosowaniu antybiotyków w leczeniu infekcji paciorkowcowych.¹⁶ Jednak nadal pozostaje ona główną przyczyną stenoz mitralnych, szczególnie u osób, które przebyły gorączkę reumatyczną przed powszechnym stosowaniem antybiotyków lub u imigrantów z krajów, gdzie choroba ta jest nadal powszechna.¹⁷¹⁸

Zwapnienie pierścieniowo-mitralne

Drugą najczęstszą przyczyną zwężenia mitralnego, szczególnie u osób starszych w krajach rozwiniętych, jest zwapnienie pierścieniowo-mitralne (mitral annular calcification, MAC).¹⁹²⁰ MAC stanowi około 12-12,5% przypadków zwężenia mitralnego.²¹²²

W przypadku tej etiologii dochodzi do postępującego odkładania się złogów wapniowych na pierścieniu zastawki mitralnej i poniżej niego, co powoduje:²³²⁴

Ograniczenie fizjologicznego rozkurczowego poszerzania pierścienia
Zmniejszenie ruchomości płatków zastawki
Utrudnienie przepływu krwi przez zastawkę

²⁵

W przeciwieństwie do zwężenia mitralnego spowodowanego gorączką reumatyczną, w przypadku MAC nie występuje zrośnięcie spoideł, a końce płatków zastawki są zwykle niezmienione.²⁶ Proces kalcyfikacji rozwija się z czasem na skutek nadmiernego napięcia i urazu pierścienia zastawki.²⁷

Czynniki sprzyjające rozwojowi zwapnienia pierścieniowo-mitralnego obejmują:²⁸²⁹

Zaawansowany wiek
Nadciśnienie tętnicze
Przewlekłą chorobę nerek, szczególnie u pacjentów dializowanych
Miażdżycę
Współistniejące zwężenie zastawki aortalnej

³⁰

Wrodzone zwężenie mitralne

Wrodzone zwężenie mitralne stanowi rzadką przyczynę tej choroby, występującą u około 0,6% pacjentów.³¹ W tej postaci niemowlęta rodzą się z nieprawidłowo ukształtowaną zastawką mitralną.³²³³

Wady wrodzone mogą obejmować różne patologie zastawki, takie jak:³⁴³⁵

Zastawka spadochronowa (parachute mitral valve)
Zastawka o podwójnym ujściu (double orifice mitral valve)
Inne nieprawidłowości strukturalne zastawki

³⁶

Wrodzone zwężenie mitralne jest najczęściej diagnozowane przed ukończeniem 2. roku życia.³⁷ Ciężkość zwężenia może się różnić od łagodnej do ciężkiej. W przypadku ciężkiego, nieleczonego zwężenia mitralnego, dzieci rzadko dożywają wieku powyżej 5 lat.³⁸ Często współistnieją inne wrodzone wady serca.³⁹

Zwężenie mitralne związane z radioterapią

Popromienne uszkodzenie zastawki mitralnej jest późnym powikłaniem radioterapii klatki piersiowej.⁴⁰⁴¹ Promieniowanie może prowadzić do pogrubienia i stwardnienia zastawki mitralnej.⁴²

Charakterystyczne cechy zwężenia mitralnego wywołanego radioterapią:⁴³⁴⁴

Uszkodzenie zastawki pojawia się zwykle 20-30 lat po ekspozycji na promieniowanie
Ryzyko jest związane z kumulacyjną dawką promieniowania
Często współistnieją inne powikłania sercowo-naczyniowe po radioterapii

⁴⁵

Inne rzadkie przyczyny zwężenia mitralnego

Istnieje szereg innych, rzadziej spotykanych przyczyn zwężenia mitralnego:⁴⁶⁴⁷⁴⁸

Choroby autoimmunologiczne:
- Toczeń rumieniowaty układowy
- Reumatoidalne zapalenie stawów
Infekcyjne zapalenie wsierdzia – duże wegetacje mogą powodować zwężenie zastawki lub naśladować objawy stenazy mitralnej
Choroby metaboliczne:
- Choroba Fabry’ego
- Choroba Whipple’a
- Mukopolisacharydozy (fenotyp Hunter-Hurler)
Złośliwy zespół rakowiaka
Włóknoelastoza wsierdzia
Inne patologie:
- Śluzak lewego przedsionka (często nie uważany za „prawdziwe” zwężenie mitralne)
- Skrzeplina zastawkowa typu „ball valve” (często nie uważana za „prawdziwe” zwężenie mitralne)
- Terapia metysergidem

⁴⁹⁵⁰⁵¹

Czynniki ryzyka zwężenia mitralnego

Istnieją określone czynniki, które zwiększają ryzyko rozwoju zwężenia mitralnego:⁵²⁵³⁵⁴

Płeć – zwężenie mitralne występuje częściej u kobiet niż u mężczyzn
Wiek – ryzyko zwężenia mitralnego spowodowanego odkładaniem się złogów wapniowych wzrasta wraz z wiekiem
Nieleczone infekcje – gorączka reumatyczna i inne infekcje mogą uszkodzić serce, jeśli nie są odpowiednio leczone
Położenie geograficzne – w regionach o większej częstości występowania gorączki reumatycznej istnieje zwiększone ryzyko zwężenia mitralnego
Wywiad rodzinny – osoby, które mają bliskich krewnych ze zwężeniem mitralnym, są bardziej narażone na rozwój tej choroby
Ekspozycja na promieniowanie – radioterapia klatki piersiowej zwiększa ryzyko zwężenia mitralnego
Nieleczony wypadanie zastawki mitralnej prowadzące do zwapnienia pierścienia mitralnego
Narkotyki – MDMA (ecstasy) zwiększa ryzyko chorób zastawki mitralnej

⁵⁵⁵⁶

Zmiany patofizjologiczne w zwężeniu mitralnym

Zwężenie zastawki mitralnej prowadzi do zwiększenia oporu dla przepływu krwi z lewego przedsionka do lewej komory w czasie rozkurczu.⁵⁷ Konsekwencje hemodynamiczne tego procesu obejmują:⁵⁸⁵⁹

Podwyższenie ciśnienia w lewym przedsionku (np. z normalnych ~10 mmHg do 25 mmHg)
Zastój krwi w lewym przedsionku prowadzący do jego powiększenia
Wzrost ciśnienia w naczyniach płucnych
Przeciążenie prawej strony serca
Zwiększone ryzyko tworzenia się skrzeplin w lewym przedsionku i powikłań zatorowych

⁶⁰⁶¹

W przypadku zwężenia mitralnego związanego z gorączką reumatyczną, naturalny przebieg choroby obejmuje bezobjawową fazę utajoną po początkowym epizodzie gorączki reumatycznej.⁶² Objawy kliniczne mogą nie pojawić się przez 5-15 lat po przebytej gorączce reumatycznej.⁶³

Podsumowanie etiologii zwężenia mitralnego

Etiologia zwężenia mitralnego jest zróżnicowana, choć dominuje gorączka reumatyczna jako najczęstsza przyczyna na świecie. W krajach rozwiniętych obserwuje się trend w kierunku zwiększania się udziału zwapnień pierścieniowo-mitralnych związanych z wiekiem jako przyczyny stenazy mitralnej, szczególnie u osób starszych.⁶⁴⁶⁵⁶⁶

Zrozumienie przyczyn zwężenia mitralnego ma kluczowe znaczenie dla właściwego postępowania diagnostycznego i terapeutycznego. Różne etiologie mogą wymagać odmiennego podejścia leczniczego, na przykład u pacjentów ze zwężeniem mitralnym spowodowanym MAC, ze względu na brak zrośnięcia spoideł, przezskórna komisurotomia balonowa nie przynosi korzyści, w przeciwieństwie do stenoz o etiologii reumatycznej.⁶⁷⁶⁸

Przyczyna zwężenia mitralnego	Częstość występowania	Charakterystyka
Gorączka reumatyczna	~85%	Zrośnięcie spoideł, pogrubienie płatków, skrócenie strun ścięgnistych
Zwapnienie pierścieniowo-mitralne (MAC)	~12-12,5%	Brak zrośnięcia spoideł, kalcyfikacja głównie w obszarze pierścienia
Wrodzone zwężenie mitralne	~0,6%	Obecne od urodzenia, często współistnieją inne wady serca
Infekcyjne zapalenie wsierdzia	~0,6%	Wegetacje mogą powodować zwężenie zastawki
Popromienne uszkodzenie zastawki	Rzadka	Pojawia się 20-30 lat po radioterapii klatki piersiowej
Choroby autoimmunologiczne	Rzadka	Toczeń rumieniowaty układowy, reumatoidalne zapalenie stawów
Choroby metaboliczne	Rzadka	Choroba Fabry’ego, choroba Whipple’a, mukopolisacharydozy

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Materiały źródłowe

#1 Mitral Stenosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/n/statpearls/article-25199/
Mitral stenosis (MS) is a form of valvular heart disease characterized by the narrowing of the mitral valve orifice. The most common cause of mitral stenosis is rheumatic fever, though the stenosis typically does not become clinically relevant until several decades later. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets and congenital heart disease. Other causes of mitral stenosis include infective endocarditis, mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, Whipple disease, Fabry disease, and rheumatoid arthritis. […] The most common cause of mitral stenosis is rheumatic fever. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets and congenital heart disease. Other causes of mitral stenosis include infective endocarditis, mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, Whipple disease, Fabry disease, and rheumatoid arthritis. […] The number one cause for most cases of mitral stenosis is rheumatic fever.
#2 Rheumatic mitral stenosis: Clinical manifestations and diagnosis – UpToDate
https://www.uptodate.com/contents/rheumatic-mitral-stenosis-clinical-manifestations-and-diagnosis
Mitral stenosis (MS) causes obstruction to blood flow from the left atrium to left ventricle. As a result, there is an increase in pressures in the left atrium, pulmonary vasculature, and right side of the heart, while the left ventricle is unaffected in isolated MS. The most common cause of MS is rheumatic heart disease with mitral commissural fusion; thickened mitral valve leaflets with restricted motion at the leaflet tips; and thickening, shortening, fusion, and calcification of the chordae tendineae. Among patients with rheumatic heart disease in resource-limited countries, some present with pure MS, some present with pure mitral regurgitation, and some present with mixed MS and mitral regurgitation. […] Severe mitral annular calcification and congenital MS are less common causes of MS.
#3 Mitral Stenosis: Background, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/897204-overview
Mitral stenosis (MS) is characterized by obstruction to left ventricular inflow at the level of mitral valve due to structural abnormality of the mitral valve apparatus. The most common cause of mitral stenosis is rheumatic fever. […] Other, less common etiologies for mitral stenosis include malignant carcinoid disease, systemic lupus erythematosus, rheumatoid arthritis, mucopolysaccharidoses of the Hunter-Hurler phenotype, Fabry disease, Whipple disease, and methysergide therapy. Congenital mitral stenosis can also occur. […] Whether the progression of valve damage is due to hemodynamic injury of the already affected valve apparatus or to the chronic inflammatory nature of the rheumatic process is unclear.
#4 Mitral valve stenosis – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159
Mitral valve stenosis can be caused by a complication of strep throat called rheumatic fever. Rheumatic fever is now rare in the United States. […] Causes of mitral valve stenosis include: Rheumatic fever. This complication of strep throat is the most common cause of mitral valve stenosis. When rheumatic fever damages the mitral valve, the condition is called rheumatic mitral valve disease. Symptoms may not be seen until years to decades after rheumatic fever. […] Calcium deposits. As you age, calcium deposits can build up around the mitral valve. This can cause narrowing of the structures that support the mitral valve flaps. The condition is called mitral annular calcification, or MAC for short. Severe MAC can cause mitral stenosis symptoms. It’s difficult to treat even with surgery. People with calcium around the mitral valve often have similar problems with the heart’s aortic valve.
#5 Mitral Valve Stenosis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/21903-mitral-valve-stenosis
Mitral valve stenosis (sometimes called mitral stenosis) is a narrowing or blockage of the mitral valve inside your heart. Over time, this condition can cause heart rhythm problems and a higher risk of stroke. It may lead to heart failure and death. […] Common causes of mitral valve stenosis include an allergic or immune reaction to a bacterial infection and calcification of the valve. Children can also have mitral valve stenosis when theyâre born (congenital). It can also happen late in life. […] Mitral valve stenosis causes include: Damage from infections: Rheumatic fever is the most common cause of mitral valve stenosis. Often called rheumatic mitral stenosis, this happens when your immune system damages the valve while fighting an untreated bacterial infection. Rheumatic mitral stenosis gets worse over time. Rheumatic mitral stenosis is most common in people around age 50, and the diagnosis is usually years or even decades after the infection happened.
#6 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
Mitral stenosis in the elderly is an evolving and complex pathological entity. The prevalence of rheumatic disease in developing countries is important and, due to migration, it continues to be seen as the first cause of mitral stenosis in developed countries. […] Nowadays, in this increasingly large section of the population, mitral valve stenosis is mainly due to sequelae of chronic rheumatic valvular disease and to calcific degeneration. The latter is supported by comorbidity and cardiovascular risk factors, which are often concomitant in frail patients. […] Rheumatic disease and degenerative calcific aetiology are the main causes contributing to the prevalence of mitral stenosis. Rheumatic disease accounts for about 85% and degenerative causes for about 12%; in all other valvular diseases this relationship is reversed.
#7 Mitral Stenosis: Etiology, Pathophysiology, and Symptomatology – OpenAnesthesia
https://www.openanesthesia.org/keywords/mitral-stenosis-etiology-pathophysiology-and-symptomatology/
Mitral stenosis (MS) is most commonly caused by rheumatic disease with characteristic mitral commissural fusion, thickened and immobile mitral valve leaflets, and fibrotic, shortened, calcified chordae tendineae. […] The etiology of MS is primarily rheumatic (85.4%), followed by degenerative (includes calcific) (12.5%), other (0.9%), endocarditis (0.6%), and congenital (0.6%). Other rare causes include congenital deformities (e.g., parachute mitral valve, double orifice mitral valve), polysaccharidosis, multi-system diseases (e.g., Fabry disease, systemic lupus erythematosus, and rheumatoid arthritis), and carcinoid syndrome. […] In degenerative MS, MAC develops over time due to excess annular tension and trauma. It has been proposed that MAC reduces the normal annular dilation during diastole and impairs anterior mitral leaflet mobility, resulting in MS.
#8 Mitral Stenosis – The Cardiology Advisor
https://www.thecardiologyadvisor.com/ddi/mitral-valve-stenosis/
Mitral stenosis (MS), also known as mitral valve stenosis, is a condition in which the opening between the left atrium and left ventricle of the heart, also known as the mitral valve orifice, is narrowed. This condition is a type of valvular heart disease. The narrowing of the mitral valve orifice can be caused by a number of issues, including infective endocarditis, mitral calcifications, congenital heart defects, and rheumatic heart disease. […] Rheumatic heart disease mitral stenosis is the most common type of mitral stenosis. […] In rheumatic heart disease, damage to the heart likely occurs because of a cross-reactive immune response that targets heart tissues while also targeting the streptococcal antigen that can be present during these infections. […] Narrowing of the mitral valve orifice caused by MS creates an increase of pressure in the left atrium and the pulmonary vasculature.
#9 Rheumatic mitral stenosis: Clinical manifestations and diagnosis – UpToDate
https://www.uptodate.com/contents/rheumatic-mitral-stenosis-clinical-manifestations-and-diagnosis
Mitral stenosis (MS) causes obstruction to blood flow from the left atrium to left ventricle. As a result, there is an increase in pressures in the left atrium, pulmonary vasculature, and right side of the heart, while the left ventricle is unaffected in isolated MS. The most common cause of MS is rheumatic heart disease with mitral commissural fusion; thickened mitral valve leaflets with restricted motion at the leaflet tips; and thickening, shortening, fusion, and calcification of the chordae tendineae. Among patients with rheumatic heart disease in resource-limited countries, some present with pure MS, some present with pure mitral regurgitation, and some present with mixed MS and mitral regurgitation. […] Severe mitral annular calcification and congenital MS are less common causes of MS.
#10 Mitral Stenosis: Etiology, Pathophysiology, and Symptomatology – OpenAnesthesia
https://www.openanesthesia.org/keywords/mitral-stenosis-etiology-pathophysiology-and-symptomatology/
Mitral stenosis (MS) is most commonly caused by rheumatic disease with characteristic mitral commissural fusion, thickened and immobile mitral valve leaflets, and fibrotic, shortened, calcified chordae tendineae. […] The etiology of MS is primarily rheumatic (85.4%), followed by degenerative (includes calcific) (12.5%), other (0.9%), endocarditis (0.6%), and congenital (0.6%). Other rare causes include congenital deformities (e.g., parachute mitral valve, double orifice mitral valve), polysaccharidosis, multi-system diseases (e.g., Fabry disease, systemic lupus erythematosus, and rheumatoid arthritis), and carcinoid syndrome. […] In degenerative MS, MAC develops over time due to excess annular tension and trauma. It has been proposed that MAC reduces the normal annular dilation during diastole and impairs anterior mitral leaflet mobility, resulting in MS.
#11 Mitral valve stenosis | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/mitral-valve-stenosis-1?lang=us
Mitral stenosis is usually acquired via rheumatic heart disease, where there is chronic inflammation of the mitral valve leaflets (mitral valvulitis) 2,3. This leads to progressive and diffuse fibrous thickening of the valve leaflets, and development of valvular calcifications 2,3. Eventually, the mitral commisures fuse and the chordae tendinae fuse 2,3. This culminates in significant immobilization and narrowing of the mitral valve, giving it a characteristic 'fish mouth’ appearance 2-4. Many patients will also have concurrent mitral regurgitation due to the valve being unable to sufficiently close 2,3. […] In addition to being a sequela of rheumatic fever, which is the most common cause world-wide, there are numerous other causes 2-4: mitral annular calcification with leaflet involvement (an age-related cause), congenital mitral stenosis, infective endocarditis, cor triatriatum, connective tissue disorders, radiation-induced heart disease, left atrial myxoma (generally not considered 'true’ mitral stenosis), ball valve thrombus (generally not considered 'true’ mitral stenosis).
#12 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
A history of rheumatic fever is present in between 50% and 70% of patients with mitral stenosis. […] The second cause of mitral stenosis in the elderly is mitral annular calcification. Currently, this anatomopathological condition is rarely considered a cause of left ventricular inflow obstruction and is underestimated. Mitral annular calcification consists in the progressive deposition of calcium above and below the valvular fibrous ring causing a reduction of leaflet mobility and therefore a hindrance to physiological diastolic annular dilation. […] Another possible cause of valvular disease, and consequently also of stenosis, is exposure to cancer therapies. The cardiotoxicity of chemotherapy and radiation therapy is a complication of oncological treatments administered 10 to 20 years earlier.
#13 Mitral valve stenosis – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159
Mitral valve stenosis can be caused by a complication of strep throat called rheumatic fever. Rheumatic fever is now rare in the United States. […] Causes of mitral valve stenosis include: Rheumatic fever. This complication of strep throat is the most common cause of mitral valve stenosis. When rheumatic fever damages the mitral valve, the condition is called rheumatic mitral valve disease. Symptoms may not be seen until years to decades after rheumatic fever. […] Calcium deposits. As you age, calcium deposits can build up around the mitral valve. This can cause narrowing of the structures that support the mitral valve flaps. The condition is called mitral annular calcification, or MAC for short. Severe MAC can cause mitral stenosis symptoms. It’s difficult to treat even with surgery. People with calcium around the mitral valve often have similar problems with the heart’s aortic valve.
#14 Mitral Valve Stenosis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/21903-mitral-valve-stenosis
Mitral valve stenosis (sometimes called mitral stenosis) is a narrowing or blockage of the mitral valve inside your heart. Over time, this condition can cause heart rhythm problems and a higher risk of stroke. It may lead to heart failure and death. […] Common causes of mitral valve stenosis include an allergic or immune reaction to a bacterial infection and calcification of the valve. Children can also have mitral valve stenosis when theyâre born (congenital). It can also happen late in life. […] Mitral valve stenosis causes include: Damage from infections: Rheumatic fever is the most common cause of mitral valve stenosis. Often called rheumatic mitral stenosis, this happens when your immune system damages the valve while fighting an untreated bacterial infection. Rheumatic mitral stenosis gets worse over time. Rheumatic mitral stenosis is most common in people around age 50, and the diagnosis is usually years or even decades after the infection happened.
#15 Mitral Valve Stenosis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/21903-mitral-valve-stenosis
Mitral valve stenosis (sometimes called mitral stenosis) is a narrowing or blockage of the mitral valve inside your heart. Over time, this condition can cause heart rhythm problems and a higher risk of stroke. It may lead to heart failure and death. […] Common causes of mitral valve stenosis include an allergic or immune reaction to a bacterial infection and calcification of the valve. Children can also have mitral valve stenosis when theyâre born (congenital). It can also happen late in life. […] Mitral valve stenosis causes include: Damage from infections: Rheumatic fever is the most common cause of mitral valve stenosis. Often called rheumatic mitral stenosis, this happens when your immune system damages the valve while fighting an untreated bacterial infection. Rheumatic mitral stenosis gets worse over time. Rheumatic mitral stenosis is most common in people around age 50, and the diagnosis is usually years or even decades after the infection happened.
#16 Causes of Mitral Valve Stenosis/Regurgitation | Stanford Health Care
https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/mitral-valve-stenosis-regurgitation/causes.html
Mitral valve stenosis occurs when the mitral valve in your heart narrows, restricting blood flow into the main pumping chamber. […] Potential stenosis causes include: Calcium buildup: As we age, calcium in the blood can collect around the mitral valve and harden it. Calcium buildup is the most common cause of mitral stenosis. […] Rheumatic heart disease: Rheumatic fever was once a common and serious complication of strep throat, but the frequency has significantly declined with the use of antibiotics. Mitral valve complications can occur years after you have rheumatic fever. […] Potential regurgitation causes, as well as factors that can increase your risk, include: Mitral valve prolapse: Prolapse is the most common cause of mitral regurgitation, and features extra tissue in the valve that keeps it from closing. Certain inherited genes can increase your risk of developing prolapse.
#17 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
Mitral stenosis in the elderly is an evolving and complex pathological entity. The prevalence of rheumatic disease in developing countries is important and, due to migration, it continues to be seen as the first cause of mitral stenosis in developed countries. […] Nowadays, in this increasingly large section of the population, mitral valve stenosis is mainly due to sequelae of chronic rheumatic valvular disease and to calcific degeneration. The latter is supported by comorbidity and cardiovascular risk factors, which are often concomitant in frail patients. […] Rheumatic disease and degenerative calcific aetiology are the main causes contributing to the prevalence of mitral stenosis. Rheumatic disease accounts for about 85% and degenerative causes for about 12%; in all other valvular diseases this relationship is reversed.
#18 Mitral Valve Disease: Types, Causes, and Symptoms
https://www.healthline.com/health/mitral-valve-disease
Mitral valve stenosis is typically caused by scarring from rheumatic fever. Usually a childhood disease, rheumatic fever results from the body’s immune response to a streptococcal bacterial infection. Rheumatic fever is a serious complication of strep throat or scarlet fever. […] If the mitral valve becomes inflamed or otherwise injured by these conditions, it can lead to the chronic heart condition called rheumatic heart disease. The clinical signs and symptoms of this condition might not occur until 5 to 10 years after the episode of rheumatic fever. […] Mitral stenosis is uncommon in the United States and other developed countries where rheumatic fever is rare. This is because people in developed countries generally have access to antibiotics that treat bacterial infections such as strep throat, according to the Merck Manual Home Health Handbook. Most cases of mitral stenosis in the United States are in older adults who had rheumatic fever before the widespread use of antibiotics or in people who have moved from countries where rheumatic fever is common. […] There are other causes of mitral valve stenosis, but these are rare. They include: blood clots, calcium buildup, congenital heart defects, radiation treatment, tumors.
#19 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
A history of rheumatic fever is present in between 50% and 70% of patients with mitral stenosis. […] The second cause of mitral stenosis in the elderly is mitral annular calcification. Currently, this anatomopathological condition is rarely considered a cause of left ventricular inflow obstruction and is underestimated. Mitral annular calcification consists in the progressive deposition of calcium above and below the valvular fibrous ring causing a reduction of leaflet mobility and therefore a hindrance to physiological diastolic annular dilation. […] Another possible cause of valvular disease, and consequently also of stenosis, is exposure to cancer therapies. The cardiotoxicity of chemotherapy and radiation therapy is a complication of oncological treatments administered 10 to 20 years earlier.
#20 Aetiology and epidemiology of mitral stenosis
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Aetiology-and-epidemiology-of-mitral-stenosis
Mitral stenosis (MS) is characterised by a narrowed valve orifice and obstruction to left ventricular inflow. Rheumatic MS, a delayed complication of rheumatic fever, is the most common aetiology for MS worldwide, while degenerative MS due to mitral annular calcification (MAC) is increasingly encountered in developed countries. […] Mitral stenosis most commonly occurs because of rheumatic fever or degenerative MV disease. Although rheumatic fever remains the predominant cause of MS worldwide, it has been largely replaced by degenerative MS in the developed countries. […] Rheumatic MS is a delayed complication of acute rheumatic fever. Antibodies to streptococcal antigens cross-react with valve tissue, with damage to the valve accumulating over decades. […] MAC is frequently observed in the elderly and is associated with hypertension, atherosclerotic disease, and often aortic stenosis.
#21 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
Mitral stenosis in the elderly is an evolving and complex pathological entity. The prevalence of rheumatic disease in developing countries is important and, due to migration, it continues to be seen as the first cause of mitral stenosis in developed countries. […] Nowadays, in this increasingly large section of the population, mitral valve stenosis is mainly due to sequelae of chronic rheumatic valvular disease and to calcific degeneration. The latter is supported by comorbidity and cardiovascular risk factors, which are often concomitant in frail patients. […] Rheumatic disease and degenerative calcific aetiology are the main causes contributing to the prevalence of mitral stenosis. Rheumatic disease accounts for about 85% and degenerative causes for about 12%; in all other valvular diseases this relationship is reversed.
#22 Mitral Stenosis: Etiology, Pathophysiology, and Symptomatology – OpenAnesthesia
https://www.openanesthesia.org/keywords/mitral-stenosis-etiology-pathophysiology-and-symptomatology/
Mitral stenosis (MS) is most commonly caused by rheumatic disease with characteristic mitral commissural fusion, thickened and immobile mitral valve leaflets, and fibrotic, shortened, calcified chordae tendineae. […] The etiology of MS is primarily rheumatic (85.4%), followed by degenerative (includes calcific) (12.5%), other (0.9%), endocarditis (0.6%), and congenital (0.6%). Other rare causes include congenital deformities (e.g., parachute mitral valve, double orifice mitral valve), polysaccharidosis, multi-system diseases (e.g., Fabry disease, systemic lupus erythematosus, and rheumatoid arthritis), and carcinoid syndrome. […] In degenerative MS, MAC develops over time due to excess annular tension and trauma. It has been proposed that MAC reduces the normal annular dilation during diastole and impairs anterior mitral leaflet mobility, resulting in MS.
#23 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
A history of rheumatic fever is present in between 50% and 70% of patients with mitral stenosis. […] The second cause of mitral stenosis in the elderly is mitral annular calcification. Currently, this anatomopathological condition is rarely considered a cause of left ventricular inflow obstruction and is underestimated. Mitral annular calcification consists in the progressive deposition of calcium above and below the valvular fibrous ring causing a reduction of leaflet mobility and therefore a hindrance to physiological diastolic annular dilation. […] Another possible cause of valvular disease, and consequently also of stenosis, is exposure to cancer therapies. The cardiotoxicity of chemotherapy and radiation therapy is a complication of oncological treatments administered 10 to 20 years earlier.
#24 Mitral Stenosis: Etiology, Pathophysiology, and Symptomatology – OpenAnesthesia
https://www.openanesthesia.org/keywords/mitral-stenosis-etiology-pathophysiology-and-symptomatology/
Mitral stenosis (MS) is most commonly caused by rheumatic disease with characteristic mitral commissural fusion, thickened and immobile mitral valve leaflets, and fibrotic, shortened, calcified chordae tendineae. […] The etiology of MS is primarily rheumatic (85.4%), followed by degenerative (includes calcific) (12.5%), other (0.9%), endocarditis (0.6%), and congenital (0.6%). Other rare causes include congenital deformities (e.g., parachute mitral valve, double orifice mitral valve), polysaccharidosis, multi-system diseases (e.g., Fabry disease, systemic lupus erythematosus, and rheumatoid arthritis), and carcinoid syndrome. […] In degenerative MS, MAC develops over time due to excess annular tension and trauma. It has been proposed that MAC reduces the normal annular dilation during diastole and impairs anterior mitral leaflet mobility, resulting in MS.
#25 Valvular Emergencies: Diagnosis and Management of Severe Mitral Stenosis | RECAPEM
https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-mitral-stenosis/
Calcific MS (aka degenerative MS) occurs via progression of this calcification along the mitral annulus, causing degeneration of the fibrous mitral support. […] Calcific MS is found with increasing frequency in the elderly population in high-income countries. […] ~8% of patients with MAC are found to have MS. […] Calcific MS is the result of calcification of the mitral annulus that extends into the leaflet bases, resulting in both the narrowing of the annulus and rigidity of the leaflets. […] In contrast to rheumatic MS, there is no commissural fusion, and the leaflet tips are usually unaffected. […] Determination of the severity of stenosis is difficult because of extensive calcification, which prevents measurement of an accurate planimetered area, and the significant abnormalities of LA and LV compliance, which cause a high gradient in the absence of severe obstruction.
#26 Valvular Emergencies: Diagnosis and Management of Severe Mitral Stenosis | RECAPEM
https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-mitral-stenosis/
Calcific MS (aka degenerative MS) occurs via progression of this calcification along the mitral annulus, causing degeneration of the fibrous mitral support. […] Calcific MS is found with increasing frequency in the elderly population in high-income countries. […] ~8% of patients with MAC are found to have MS. […] Calcific MS is the result of calcification of the mitral annulus that extends into the leaflet bases, resulting in both the narrowing of the annulus and rigidity of the leaflets. […] In contrast to rheumatic MS, there is no commissural fusion, and the leaflet tips are usually unaffected. […] Determination of the severity of stenosis is difficult because of extensive calcification, which prevents measurement of an accurate planimetered area, and the significant abnormalities of LA and LV compliance, which cause a high gradient in the absence of severe obstruction.
#27 Mitral Stenosis: Etiology, Pathophysiology, and Symptomatology – OpenAnesthesia
https://www.openanesthesia.org/keywords/mitral-stenosis-etiology-pathophysiology-and-symptomatology/
Mitral stenosis (MS) is most commonly caused by rheumatic disease with characteristic mitral commissural fusion, thickened and immobile mitral valve leaflets, and fibrotic, shortened, calcified chordae tendineae. […] The etiology of MS is primarily rheumatic (85.4%), followed by degenerative (includes calcific) (12.5%), other (0.9%), endocarditis (0.6%), and congenital (0.6%). Other rare causes include congenital deformities (e.g., parachute mitral valve, double orifice mitral valve), polysaccharidosis, multi-system diseases (e.g., Fabry disease, systemic lupus erythematosus, and rheumatoid arthritis), and carcinoid syndrome. […] In degenerative MS, MAC develops over time due to excess annular tension and trauma. It has been proposed that MAC reduces the normal annular dilation during diastole and impairs anterior mitral leaflet mobility, resulting in MS.
#28 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
Mitral stenosis is recognised as a chronic rheumatic heart disease and therefore as a consequence of acute rheumatic fever even when the patient has no history of rheumatic fever, probably as a result of a missed diagnosis. […] Calcification at the level of the mitral annulus can determine haemodynamically significant obstruction due to the impairment of physiological diastolic annular dilatation and the reduction of leaflet motion. […] Among the promoters of the development of mitral annular calcification, disorders of tissue mineralisation play a key role that is particularly evident in elderly patients with chronic kidney disease and even more in those on dialysis. […] The increase in the average age of the population with the majority represented by the elderly is also due to the improvement in the quality and possibility of treatment. This is particularly true in the cardiovascular and oncological fields, which are the main areas of disease prevalence in the elderly population. Therefore, there is an increase in the prevalence of cancer survivors and, at the same time, of long-term complications of cancer treatment. One of these is the development of cardiotoxicity with possible damage to all the components of the heart from the pericardium to the conduction system passing through the myocardium and the valvular apparatus.
#29 Aetiology and epidemiology of mitral stenosis
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Aetiology-and-epidemiology-of-mitral-stenosis
Mitral stenosis (MS) is characterised by a narrowed valve orifice and obstruction to left ventricular inflow. Rheumatic MS, a delayed complication of rheumatic fever, is the most common aetiology for MS worldwide, while degenerative MS due to mitral annular calcification (MAC) is increasingly encountered in developed countries. […] Mitral stenosis most commonly occurs because of rheumatic fever or degenerative MV disease. Although rheumatic fever remains the predominant cause of MS worldwide, it has been largely replaced by degenerative MS in the developed countries. […] Rheumatic MS is a delayed complication of acute rheumatic fever. Antibodies to streptococcal antigens cross-react with valve tissue, with damage to the valve accumulating over decades. […] MAC is frequently observed in the elderly and is associated with hypertension, atherosclerotic disease, and often aortic stenosis.
#30 Mitral Valve Stenosis: Symptoms & Causes | Mass General Brigham
https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/mitral-valve-stenosis
Mitral valve stenosis occurs when the opening between the two left chambers of the heart is too narrow, becomes blocked, or can’t open completely. […] The most common cause of mitral stenosis is a complication of strep throat called rheumatic fever, which can cause scar tissue to form on the leaflets of the mitral valve, causing its narrowing. […] Other causes include: Wear and tear (degeneration): Calcium deposits can form in the heart as we age, eventually blocking the valve. […] Congenital (present at birth) heart defects: Some babies are born with a narrow mitral valve because the heart didn’t form correctly during the baby’s development. […] Significant risk factors for mitral stenosis include: Age: Older adults are more likely to have mitral stenosis caused by calcium buildup.
#31 Mitral Stenosis: Etiology, Pathophysiology, and Symptomatology – OpenAnesthesia
https://www.openanesthesia.org/keywords/mitral-stenosis-etiology-pathophysiology-and-symptomatology/
Mitral stenosis (MS) is most commonly caused by rheumatic disease with characteristic mitral commissural fusion, thickened and immobile mitral valve leaflets, and fibrotic, shortened, calcified chordae tendineae. […] The etiology of MS is primarily rheumatic (85.4%), followed by degenerative (includes calcific) (12.5%), other (0.9%), endocarditis (0.6%), and congenital (0.6%). Other rare causes include congenital deformities (e.g., parachute mitral valve, double orifice mitral valve), polysaccharidosis, multi-system diseases (e.g., Fabry disease, systemic lupus erythematosus, and rheumatoid arthritis), and carcinoid syndrome. […] In degenerative MS, MAC develops over time due to excess annular tension and trauma. It has been proposed that MAC reduces the normal annular dilation during diastole and impairs anterior mitral leaflet mobility, resulting in MS.
#32 Mitral valve stenosis – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159
Radiation therapy. This is a treatment for certain types of cancer. Radiation to the chest area can sometimes cause the mitral valve to thicken and harden. The heart valve damage typically occurs 20 to 30 years after radiation therapy. […] Heart condition present at birth, called a congenital heart defect. Rarely, some babies are born with a narrowed mitral valve. […] Other health conditions. Lupus and other autoimmune conditions may rarely cause mitral valve stenosis.
#33 Aetiology and epidemiology of mitral stenosis
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Aetiology-and-epidemiology-of-mitral-stenosis
The hallmark of degenerative MS is MAC. Development of MAC is a chronic process involving degenerative changes in the mitral annulus leading to its calcification. […] Congenital mitral stenosis is an extremely rare condition mostly diagnosed in utero or soon after birth. […] Radiation-induced MV disease is a late complication of radiation to the chest. It generally presents two to three decades after radiotherapy and is related to the cumulative dose of radiation.
#34 Mitral valve stenosis | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/mitral-valve-stenosis-1?lang=us
Mitral stenosis is usually acquired via rheumatic heart disease, where there is chronic inflammation of the mitral valve leaflets (mitral valvulitis) 2,3. This leads to progressive and diffuse fibrous thickening of the valve leaflets, and development of valvular calcifications 2,3. Eventually, the mitral commisures fuse and the chordae tendinae fuse 2,3. This culminates in significant immobilization and narrowing of the mitral valve, giving it a characteristic 'fish mouth’ appearance 2-4. Many patients will also have concurrent mitral regurgitation due to the valve being unable to sufficiently close 2,3. […] In addition to being a sequela of rheumatic fever, which is the most common cause world-wide, there are numerous other causes 2-4: mitral annular calcification with leaflet involvement (an age-related cause), congenital mitral stenosis, infective endocarditis, cor triatriatum, connective tissue disorders, radiation-induced heart disease, left atrial myxoma (generally not considered 'true’ mitral stenosis), ball valve thrombus (generally not considered 'true’ mitral stenosis).
#35 Mitral Stenosis: Etiology, Pathophysiology, and Symptomatology – OpenAnesthesia
https://www.openanesthesia.org/keywords/mitral-stenosis-etiology-pathophysiology-and-symptomatology/
Mitral stenosis (MS) is most commonly caused by rheumatic disease with characteristic mitral commissural fusion, thickened and immobile mitral valve leaflets, and fibrotic, shortened, calcified chordae tendineae. […] The etiology of MS is primarily rheumatic (85.4%), followed by degenerative (includes calcific) (12.5%), other (0.9%), endocarditis (0.6%), and congenital (0.6%). Other rare causes include congenital deformities (e.g., parachute mitral valve, double orifice mitral valve), polysaccharidosis, multi-system diseases (e.g., Fabry disease, systemic lupus erythematosus, and rheumatoid arthritis), and carcinoid syndrome. […] In degenerative MS, MAC develops over time due to excess annular tension and trauma. It has been proposed that MAC reduces the normal annular dilation during diastole and impairs anterior mitral leaflet mobility, resulting in MS.
#36 Valvular Emergencies: Diagnosis and Management of Severe Mitral Stenosis | RECAPEM
https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-mitral-stenosis/
Rheumatic heart disease […] Mitral annular calcification (MAC). More on this below. […] Infective endocarditis […] Prosthetic valve thrombosis […] Other rare conditions […] Congenital mitral stenosis […] Radiation-associated valve disease […] Fabry disease, Whipple disease, mucopolysaccharidosis […] Carcinoid valve disease […] Endomyocardial fibrosis […] Systemic rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis. […] Note that almost all cases of mitral stenosis are primary MS (i.e., MS is caused by pathologies that affect the mitral valve apparatus). […] Mitral annular calcification (MAC) is generally an incidental finding associated with aging, although it is occasionally prominent enough to cause mitral stenosis, mitral regurgitation, or both (mixed disease).
#37 Mitral Valve Stenosis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/21903-mitral-valve-stenosis
Wear and tear due to age: This type of stenosis is more likely with advancing age and results from calcium buildup on the valve. But many people with age-related mitral stenosis have only mild or moderate narrowing and may not need treatment. Typically, calcification occurs naturally as we age but certain conditions, like kidney disease or radiation, can accelerate it. […] Present at birth. Providers usually detect congenital (present at birth) mitral stenosis before the age of 2. This kind of stenosis can range from mild to severe. If not treated, children with severe mitral stenosis typically donât survive past age 5.
#38 Mitral Valve Stenosis: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/21903-mitral-valve-stenosis
Wear and tear due to age: This type of stenosis is more likely with advancing age and results from calcium buildup on the valve. But many people with age-related mitral stenosis have only mild or moderate narrowing and may not need treatment. Typically, calcification occurs naturally as we age but certain conditions, like kidney disease or radiation, can accelerate it. […] Present at birth. Providers usually detect congenital (present at birth) mitral stenosis before the age of 2. This kind of stenosis can range from mild to severe. If not treated, children with severe mitral stenosis typically donât survive past age 5.
#39 Mitral stenosis: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/000175.htm
Mitral stenosis is a disorder in which the mitral valve does not fully open. This restricts the flow of blood. […] In adults, mitral stenosis occurs most often in people who have had rheumatic fever. This is a disease that can develop after an illness with strep throat that was not properly treated. […] Rarely, other factors can cause mitral stenosis in adults. These include: Calcium deposits forming around the mitral valve, Radiation treatment to the chest, Some medicines. […] Children may be born with mitral stenosis (congenital) or other birth defects involving the heart that cause mitral stenosis. Often, there are other heart defects present along with the mitral stenosis. […] Mitral stenosis may run in families.
#40 Mitral valve stenosis – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159
Radiation therapy. This is a treatment for certain types of cancer. Radiation to the chest area can sometimes cause the mitral valve to thicken and harden. The heart valve damage typically occurs 20 to 30 years after radiation therapy. […] Heart condition present at birth, called a congenital heart defect. Rarely, some babies are born with a narrowed mitral valve. […] Other health conditions. Lupus and other autoimmune conditions may rarely cause mitral valve stenosis.
#41 Aetiology and epidemiology of mitral stenosis
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Aetiology-and-epidemiology-of-mitral-stenosis
The hallmark of degenerative MS is MAC. Development of MAC is a chronic process involving degenerative changes in the mitral annulus leading to its calcification. […] Congenital mitral stenosis is an extremely rare condition mostly diagnosed in utero or soon after birth. […] Radiation-induced MV disease is a late complication of radiation to the chest. It generally presents two to three decades after radiotherapy and is related to the cumulative dose of radiation.
#42 Mitral Valve Stenosis Causes, Symptoms & Treatment
https://www.thekeyholeheartclinic.com/services/valve-disorders/mitral-valve2/mitral-stenosis/
Mitral valve stenosis describes a condition involving thickening and calcification of the mitral valve, which causes the valve to fail to open properly. This condition is most commonly caused by rheumatic fever, which is a result of the bodys immune response to an infection in early age. […] However, there are several other causes to be aware of, including: […] Calcium deposits as you age, calcium deposits can build up around the mitral valve, which can occasionally cause stenosis. […] Radiation therapy treatment for certain types of cancer that require radiation to your chest area can sometimes cause the valve to thicken and harden. […] Congenital defects in rare cases, people can be born with a narrowed mitral valve, which can cause problems over time.
#43 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
Mitral stenosis is recognised as a chronic rheumatic heart disease and therefore as a consequence of acute rheumatic fever even when the patient has no history of rheumatic fever, probably as a result of a missed diagnosis. […] Calcification at the level of the mitral annulus can determine haemodynamically significant obstruction due to the impairment of physiological diastolic annular dilatation and the reduction of leaflet motion. […] Among the promoters of the development of mitral annular calcification, disorders of tissue mineralisation play a key role that is particularly evident in elderly patients with chronic kidney disease and even more in those on dialysis. […] The increase in the average age of the population with the majority represented by the elderly is also due to the improvement in the quality and possibility of treatment. This is particularly true in the cardiovascular and oncological fields, which are the main areas of disease prevalence in the elderly population. Therefore, there is an increase in the prevalence of cancer survivors and, at the same time, of long-term complications of cancer treatment. One of these is the development of cardiotoxicity with possible damage to all the components of the heart from the pericardium to the conduction system passing through the myocardium and the valvular apparatus.
#44 Aetiology and epidemiology of mitral stenosis
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Aetiology-and-epidemiology-of-mitral-stenosis
The hallmark of degenerative MS is MAC. Development of MAC is a chronic process involving degenerative changes in the mitral annulus leading to its calcification. […] Congenital mitral stenosis is an extremely rare condition mostly diagnosed in utero or soon after birth. […] Radiation-induced MV disease is a late complication of radiation to the chest. It generally presents two to three decades after radiotherapy and is related to the cumulative dose of radiation.
#45 Mitral valve stenosis – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159
Radiation therapy. This is a treatment for certain types of cancer. Radiation to the chest area can sometimes cause the mitral valve to thicken and harden. The heart valve damage typically occurs 20 to 30 years after radiation therapy. […] Heart condition present at birth, called a congenital heart defect. Rarely, some babies are born with a narrowed mitral valve. […] Other health conditions. Lupus and other autoimmune conditions may rarely cause mitral valve stenosis.
#46 Mitral Stenosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/n/statpearls/article-25199/
Mitral stenosis (MS) is a form of valvular heart disease characterized by the narrowing of the mitral valve orifice. The most common cause of mitral stenosis is rheumatic fever, though the stenosis typically does not become clinically relevant until several decades later. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets and congenital heart disease. Other causes of mitral stenosis include infective endocarditis, mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, Whipple disease, Fabry disease, and rheumatoid arthritis. […] The most common cause of mitral stenosis is rheumatic fever. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets and congenital heart disease. Other causes of mitral stenosis include infective endocarditis, mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, Whipple disease, Fabry disease, and rheumatoid arthritis. […] The number one cause for most cases of mitral stenosis is rheumatic fever.
#47 Mitral Stenosis: Background, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/897204-overview
Mitral stenosis (MS) is characterized by obstruction to left ventricular inflow at the level of mitral valve due to structural abnormality of the mitral valve apparatus. The most common cause of mitral stenosis is rheumatic fever. […] Other, less common etiologies for mitral stenosis include malignant carcinoid disease, systemic lupus erythematosus, rheumatoid arthritis, mucopolysaccharidoses of the Hunter-Hurler phenotype, Fabry disease, Whipple disease, and methysergide therapy. Congenital mitral stenosis can also occur. […] Whether the progression of valve damage is due to hemodynamic injury of the already affected valve apparatus or to the chronic inflammatory nature of the rheumatic process is unclear.
#48 Mitral stenosis – Wikipedia
https://en.wikipedia.org/wiki/Mitral_stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. […] Almost all cases of mitral stenosis are due to disease in the heart secondary to rheumatic fever and the consequent rheumatic heart disease. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets, and as a form of congenital heart disease. Other causes include infective endocarditis where the vegetations may favor increase risk of stenosis. Other rare causes include mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, whipple disease, fabry disease, and rheumatoid arthritis. […] The natural history of mitral stenosis secondary to rheumatic fever (the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever.
#49 Valvular Emergencies: Diagnosis and Management of Severe Mitral Stenosis | RECAPEM
https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-mitral-stenosis/
Rheumatic heart disease […] Mitral annular calcification (MAC). More on this below. […] Infective endocarditis […] Prosthetic valve thrombosis […] Other rare conditions […] Congenital mitral stenosis […] Radiation-associated valve disease […] Fabry disease, Whipple disease, mucopolysaccharidosis […] Carcinoid valve disease […] Endomyocardial fibrosis […] Systemic rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis. […] Note that almost all cases of mitral stenosis are primary MS (i.e., MS is caused by pathologies that affect the mitral valve apparatus). […] Mitral annular calcification (MAC) is generally an incidental finding associated with aging, although it is occasionally prominent enough to cause mitral stenosis, mitral regurgitation, or both (mixed disease).
#50 Mitral Stenosis: Etiology, Pathophysiology, and Symptomatology – OpenAnesthesia
https://www.openanesthesia.org/keywords/mitral-stenosis-etiology-pathophysiology-and-symptomatology/
Mitral stenosis (MS) is most commonly caused by rheumatic disease with characteristic mitral commissural fusion, thickened and immobile mitral valve leaflets, and fibrotic, shortened, calcified chordae tendineae. […] The etiology of MS is primarily rheumatic (85.4%), followed by degenerative (includes calcific) (12.5%), other (0.9%), endocarditis (0.6%), and congenital (0.6%). Other rare causes include congenital deformities (e.g., parachute mitral valve, double orifice mitral valve), polysaccharidosis, multi-system diseases (e.g., Fabry disease, systemic lupus erythematosus, and rheumatoid arthritis), and carcinoid syndrome. […] In degenerative MS, MAC develops over time due to excess annular tension and trauma. It has been proposed that MAC reduces the normal annular dilation during diastole and impairs anterior mitral leaflet mobility, resulting in MS.
#51 Mitral Stenosis | Doctor
https://patient.info/doctor/mitral-stenosis-pro
Mitral stenosis may be associated with other heart valve lesions – eg, tricuspid regurgitation. […] Causes of mitral stenosis include: Rheumatic fever (the most common cause). […] Degenerative calcification (can occur in the elderly). […] Congenital mitral stenosis (secondary to parachute mitral valve or Lutembacher’s syndrome). […] Inborn errors of metabolism (eg, Hurler-Scheie syndrome, Anderson-Fabry disease). […] Systemic lupus erythematosus. […] Rheumatoid arthritis. […] Carcinoid syndrome. […] Infective endocarditis with large vegetations. […] Amyloid deposition in the mitral valve.
#52 Mitral Valve Stenosis: Symptoms & Causes | Mass General Brigham
https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/mitral-valve-stenosis
Mitral valve stenosis occurs when the opening between the two left chambers of the heart is too narrow, becomes blocked, or can’t open completely. […] The most common cause of mitral stenosis is a complication of strep throat called rheumatic fever, which can cause scar tissue to form on the leaflets of the mitral valve, causing its narrowing. […] Other causes include: Wear and tear (degeneration): Calcium deposits can form in the heart as we age, eventually blocking the valve. […] Congenital (present at birth) heart defects: Some babies are born with a narrow mitral valve because the heart didn’t form correctly during the baby’s development. […] Significant risk factors for mitral stenosis include: Age: Older adults are more likely to have mitral stenosis caused by calcium buildup.
#53 Mitral Valve Stenosis: Symptoms & Causes | Mass General Brigham
https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/mitral-valve-stenosis
Gender: Mitral stenosis is more common among biological females. […] Untreated infections: Rheumatic fever and other infections can damage the heart if left untreated. […] Radiation: Exposure to chest radiation, such as radiotherapy for cancer, can increase your risk of mitral valve disease. […] Family history: People who have a close relative with mitral stenosis are more likely to develop the condition. […] Untreated mitral valve prolapse that progressed to mitral annular calcification (MAC) […] Illegal drugs: MDMA (ecstasy) increases the risk of mitral valve disorders.
#54 Mitral Valve Stenosis
https://med.uth.edu/heartandvascular/mitral-valve-stenosis/
Mitral valve stenosis is a condition characterized by the narrowing or tightening of the mitral valve, which is located between the left atrium and the left ventricle of the heart. […] The most common cause of mitral valve stenosis is rheumatic fever, which is a complication of untreated streptococcal throat infection. Other less common causes include congenital heart defects affecting the mitral valve, blood clot formation, or certain autoimmune conditions. […] History of rheumatic fever: This inflammatory condition can lead to scarring and thickening of the mitral valve. […] Age: Mitral valve stenosis is more commonly seen in individuals who had rheumatic fever in childhood or adolescence. […] Gender: Females are more likely to develop mitral valve stenosis than males. […] Geographic location: Certain regions with a higher prevalence of rheumatic fever have an increased risk of mitral valve stenosis.
#55 Mitral Valve Stenosis: Symptoms & Causes | Mass General Brigham
https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/mitral-valve-stenosis
Gender: Mitral stenosis is more common among biological females. […] Untreated infections: Rheumatic fever and other infections can damage the heart if left untreated. […] Radiation: Exposure to chest radiation, such as radiotherapy for cancer, can increase your risk of mitral valve disease. […] Family history: People who have a close relative with mitral stenosis are more likely to develop the condition. […] Untreated mitral valve prolapse that progressed to mitral annular calcification (MAC) […] Illegal drugs: MDMA (ecstasy) increases the risk of mitral valve disorders.
#56 Mitral Valve Stenosis
https://med.uth.edu/heartandvascular/mitral-valve-stenosis/
Mitral valve stenosis is a condition characterized by the narrowing or tightening of the mitral valve, which is located between the left atrium and the left ventricle of the heart. […] The most common cause of mitral valve stenosis is rheumatic fever, which is a complication of untreated streptococcal throat infection. Other less common causes include congenital heart defects affecting the mitral valve, blood clot formation, or certain autoimmune conditions. […] History of rheumatic fever: This inflammatory condition can lead to scarring and thickening of the mitral valve. […] Age: Mitral valve stenosis is more commonly seen in individuals who had rheumatic fever in childhood or adolescence. […] Gender: Females are more likely to develop mitral valve stenosis than males. […] Geographic location: Certain regions with a higher prevalence of rheumatic fever have an increased risk of mitral valve stenosis.
#57 CV Physiology | Valvular Stenosis
https://cvphysiology.com/heart-disease/hd004
Mitral valve stenosis results from a narrowing of the opened mitral valve orifice so that it is more difficult for blood to flow from the left atrium (LA) into the left ventricle (LV) during ventricular diastole. […] The high resistance across the stenotic mitral valve causes blood to back up into the left atrium, increasing LA pressure, which in this example is 25 mmHg (normally ~10 mmHg). […] The increase in LA pressure can cause pulmonary congestion and edema because of increased pulmonary capillary hydrostatic pressure.
#58 Mitral valve disease – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mitral-valve-disease/symptoms-causes/syc-20355107
Mitral valve stenosis, shown in the heart on the right, is a condition in which the heart’s mitral valve is narrowed. The valve doesn’t open properly, blocking blood flow coming into the left ventricle, the main pumping chamber of the heart. […] The flaps of the mitral valve become thick or stiff, and they can fuse together. This narrows the valve opening, which reduces blood flow from the left atrium to the left ventricle. […] For example, mitral valve stenosis is often caused by rheumatic fever. This fever is a complication of a strep infection that can affect the heart. When this happens, it’s called rheumatic mitral valve disease. […] In mitral valve stenosis, the valve opening narrows. The heart now must work harder to force blood through the smaller valve opening. If the opening in the valve becomes small enough, it can reduce blood flow between the left heart chambers.
#59 CV Physiology | Valvular Stenosis
https://cvphysiology.com/heart-disease/hd004
Mitral valve stenosis results from a narrowing of the opened mitral valve orifice so that it is more difficult for blood to flow from the left atrium (LA) into the left ventricle (LV) during ventricular diastole. […] The high resistance across the stenotic mitral valve causes blood to back up into the left atrium, increasing LA pressure, which in this example is 25 mmHg (normally ~10 mmHg). […] The increase in LA pressure can cause pulmonary congestion and edema because of increased pulmonary capillary hydrostatic pressure.
#60 CV Physiology | Valvular Stenosis
https://cvphysiology.com/heart-disease/hd004
Mitral valve stenosis results from a narrowing of the opened mitral valve orifice so that it is more difficult for blood to flow from the left atrium (LA) into the left ventricle (LV) during ventricular diastole. […] The high resistance across the stenotic mitral valve causes blood to back up into the left atrium, increasing LA pressure, which in this example is 25 mmHg (normally ~10 mmHg). […] The increase in LA pressure can cause pulmonary congestion and edema because of increased pulmonary capillary hydrostatic pressure.
#61 Mitral valve stenosis: Causes, symptoms, and treatment
https://www.medicalnewstoday.com/articles/mitral-valve-stenosis
Mitral valve stenosis is a form of valvular heart disease. It occurs when there is a narrowing of the mitral valve, which restricts the flow of blood from the left atrium to the left ventricle. […] The most common cause of MVS is rheumatic heart disease (RHD). […] RHD can occur when a person has had rheumatic fever, which results from an untreated strep infection and can damage the valves in the heart. […] Other causes of MVS include calcific mitral stenosis, congenital heart defects (CHDs), and lupus. […] MVS is a type of valvular heart disease that causes the narrowing and hardening of the mitral valve. This restricts the flow of blood through the heart and increases the pressure in the left atrium, causing the left atrium to enlarge. […] The most common cause of MVS is rheumatic heart disease, resulting from rheumatic fever. Symptoms may not present until 10-15 years after an episode of rheumatic fever.
#62 Mitral stenosis – Wikipedia
https://en.wikipedia.org/wiki/Mitral_stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. […] Almost all cases of mitral stenosis are due to disease in the heart secondary to rheumatic fever and the consequent rheumatic heart disease. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets, and as a form of congenital heart disease. Other causes include infective endocarditis where the vegetations may favor increase risk of stenosis. Other rare causes include mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, whipple disease, fabry disease, and rheumatoid arthritis. […] The natural history of mitral stenosis secondary to rheumatic fever (the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever.
#63 Mitral valve stenosis: Causes, symptoms, and treatment
https://www.medicalnewstoday.com/articles/mitral-valve-stenosis
Mitral valve stenosis is a form of valvular heart disease. It occurs when there is a narrowing of the mitral valve, which restricts the flow of blood from the left atrium to the left ventricle. […] The most common cause of MVS is rheumatic heart disease (RHD). […] RHD can occur when a person has had rheumatic fever, which results from an untreated strep infection and can damage the valves in the heart. […] Other causes of MVS include calcific mitral stenosis, congenital heart defects (CHDs), and lupus. […] MVS is a type of valvular heart disease that causes the narrowing and hardening of the mitral valve. This restricts the flow of blood through the heart and increases the pressure in the left atrium, causing the left atrium to enlarge. […] The most common cause of MVS is rheumatic heart disease, resulting from rheumatic fever. Symptoms may not present until 10-15 years after an episode of rheumatic fever.
#64 Mitral valve stenosis: epidemiology and causes in elderly patients
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients
An active understanding of changes in population characteristics and their consequences on the aetiological evolution allows us to continue to improve and personalise the currently available therapies for complex pathologies. Likewise, at the end of the transition we are currently observing, mitral stenosis will have a higher prevalence in the elderly population with a predominantly degenerative and calcific aetiology.
#65 Aetiology and epidemiology of mitral stenosis
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Aetiology-and-epidemiology-of-mitral-stenosis
Mitral stenosis (MS) is characterised by a narrowed valve orifice and obstruction to left ventricular inflow. Rheumatic MS, a delayed complication of rheumatic fever, is the most common aetiology for MS worldwide, while degenerative MS due to mitral annular calcification (MAC) is increasingly encountered in developed countries. […] Mitral stenosis most commonly occurs because of rheumatic fever or degenerative MV disease. Although rheumatic fever remains the predominant cause of MS worldwide, it has been largely replaced by degenerative MS in the developed countries. […] Rheumatic MS is a delayed complication of acute rheumatic fever. Antibodies to streptococcal antigens cross-react with valve tissue, with damage to the valve accumulating over decades. […] MAC is frequently observed in the elderly and is associated with hypertension, atherosclerotic disease, and often aortic stenosis.
#66 Heart valve disease module 1: epidemiology – The British Journal of Cardiology
https://bjcardio.co.uk/2016/03/heart-valve-disease-module-1-epidemiology-2/5/
Rheumatic disease is the overwhelming aetiology world-wide and causes isolated mitral stenosis in 40% of cases. […] In industrially developed regions diseases of old age predominate, particularly calcific aortic stenosis and functional mitral regurgitation.
#67 Mitral Stenosis – Cardiovascular Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/cardiovascular-disorders/valvular-disorders/mitral-stenosis
Mitral stenosis is narrowing of the mitral orifice that impedes blood flow from the left atrium to the left ventricle. The usual cause is rheumatic fever. […] The most common cause is rheumatic fever. […] An increasingly prevalent cause in older patients is mitral annular calcification with extension of calcification into the leaflets, causing them to stiffen and not open fully. […] Occasionally, mitral stenosis is congenital or occurs after radiation therapy. […] When the etiology is annular calcification, there is no benefit from percutaneous balloon commissurotomy because there is no commissural fusion.
#68 Valvular Emergencies: Diagnosis and Management of Severe Mitral Stenosis | RECAPEM
https://recapem.com/valvular-emergencies-diagnosis-and-management-of-severe-mitral-stenosis/
These patients are at high risk with any intervention because of the extensive calcification, as well as advanced age and multiple comorbidities. […] Thus, in patients with calcific MS, the indications for any intervention differ from those for rheumatic MS, and intervention for calcific MS should be performed only in highly symptomatic patients. […] false