Mitral stenosis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
After the initial episode of rheumatic fever, there is a latent period of 20 years before the onset of symptoms in mitral stenosis. Complications of mitral stenosis are left and right heart failure, endocarditis and embolization (stroke) and pulmonary embolism. Survival in asymptomatic patients is 80% at 10 years. Once symptoms develop, if mitral stenosis is left untreated, survival at 10 years is only 15%. The majority of patients die due to complications of pulmonary hypertension (which is associated with a mean survival of 3 years after its onset) and right heart failure.
Natural History
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. This latent period lasts an average of 16.3 ± 5.2 years. Once symptoms of mitral stenosis begin to develop, progression to severe disability takes 9.2 ± 4.3 years. In some areas of the developing world, the rate of progression is more rapid due to repeated infections, poorer treatment of the infections, or more virulent infections and the patient may be symptomatic as early as the late teens. Death from mitral stenosis is due to the progressive increase in pulmonary capillary wedge pressure, pulmonary hypertension, and subsequent right-sided heart failure. This is the cause of death in 60 percent of mitral stenosis cases that are not treated. Other less frequent causes of death include:[1][2][3][4][5][6]
- Stroke (20%-30%)
- Pulmonary embolism (10%)
- Infective endocarditis (1-5%)
Complications
- Complications of mitral stenosis are left and right heart failure, endocarditis, and embolization.[4]
- Atrial fibrillation and other arrhythmias. It is the most common cause of disability from the disease in patients who were previously asymptomatic.[6][4]
- Shown below is a list of the manifestations of the complications of mitral stenosis:[7]
- Pulmonary edema
- Hemoptysis and pulmonary hemorrhage
- Thromboembolic events (pulmonary embolism and stroke, mostly due to atrial fibrillation)
- Pulmonary hypertension
- Right ventricular failure
- Tricuspid regurgitation
- Pedal edema
- Ascites
- Congestive hepatopathy
Prognosis
Asymptomatic Patients
Survival is >80% at 10 years.[3][8]
Symptomatic Patients Without Treatment
In individuals who were offered mitral valve surgery but refused, survival with medical therapy alone was 44 ± 6 % at 5 years, and 32 ± 8 % at 10 years after they were offered correction.[9]
Presence of Pulmonary Hypertension
In the presence of pulmonary hypertension, the mean survival is less than 3 years.
References
- ↑ Abernathy WS, Willis PW (1973). "Thromboembolic complications of rheumatic heart disease". Cardiovasc Clin. 5 (2): 131–75. PMID 4780192.
- ↑ OLESEN KH (1962). "The natural history of 271 patients with mitral stenosis under medical treatment". Br Heart J. 24: 349–57. PMC 1017892. PMID 14481743.
- ↑ 3.0 3.1 WILSON JK, GREENWOOD WF (1954). "The natural history of mitral stenosis". Can Med Assoc J. 71 (4): 323–31. PMC 1824874. PMID 13199730.
- ↑ 4.0 4.1 4.2 Selzer A, Cohn KE (1972). "Natural history of mitral stenosis: a review". Circulation. 45 (4): 878–90. PMID 4552598.
- ↑ Selzer A, Cohn KE (April 1972). "Natural history of mitral stenosis: a review". Circulation. 45 (4): 878–90. doi:10.1161/01.cir.45.4.878. PMID 4552598.
- ↑ 6.0 6.1 ROWE JC, BLAND EF, SPRAGUE HB, WHITE PD (1960). "The course of mitral stenosis without surgery: ten- and twenty-year perspectives". Ann Intern Med. 52: 741–9. PMID 14439687.
- ↑ Neilson GH, Galea EG, Hossack KF (August 1978). "Thromboembolic complications of mitral valve disease". Aust N Z J Med. 8 (4): 372–6. doi:10.1111/j.1445-5994.1978.tb04904.x. PMID 282850.
- ↑ Rahimtoola SH, Durairaj A, Mehra A, Nuno I (2002). "Current evaluation and management of patients with mitral stenosis". Circulation. 106 (10): 1183–8. PMID 12208789.
- ↑ Carabello BA (2005). "Modern management of mitral stenosis". Circulation. 112 (3): 432–7. doi:10.1161/CIRCULATIONAHA.104.532498. PMID 16027271.