Nina C Wunderlich1, Bharat Dalvi2, Siew Yen Ho3, Harald Küx4, Robert J Siegel5. 1. Cardiovascular Center Darmstadt, Darmstadt, Germany. wunderlich@kardio-darmstadt.de. 2. Glenmark Cardiac Centre, Mumbai, India. 3. Cardiac Morphology Unit, Royal Brompton Hospital, London, England. 4. Cardiovascular Center Darmstadt, Darmstadt, Germany. 5. The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Abstract
PURPOSE OF REVIEW: This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS). RECENT FINDINGS: While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Pre-procedural evaluation for treatment of MS using a multimodality approach with 2D and 3D transthoracic and transesophageal echo, stress echo, cardiac CT scanning, and cardiac MRI as well as hemodynamic assessment by cardiac catheterization is discussed. The current methods of percutaneous mitral balloon commissurotomy (PMBC) and surgery are also discussed. New data on long-term follow-up after PMBC is also presented. For severe rheumatic MS, medical therapy is ineffective and definitive therapy entails PMBC in patients with suitable morphological mitral valve (MV) characteristics, or surgery. As procedural outcomes depend heavily on appropriate case selection, definitive imaging and interpretation are crucial. It is also important to understand the indications as well as morphological MV characteristics to identify the appropriate treatment with PMBC or surgery.
PURPOSE OF REVIEW: This review provides an update on rheumatic mitral stenosis. Acute rheumatic fever (RF), the sequela of group A β-hemolytic streptococcal infection, is the major etiology for mitral stenosis (MS). RECENT FINDINGS: While the incidence of acute RF in the Western world had substantially declined over the past five decades, this trend is reversing due to immigration from non-industrialized countries where rheumatic heart disease (RHD) is higher. Pre-procedural evaluation for treatment of MS using a multimodality approach with 2D and 3D transthoracic and transesophageal echo, stress echo, cardiac CT scanning, and cardiac MRI as well as hemodynamic assessment by cardiac catheterization is discussed. The current methods of percutaneous mitral balloon commissurotomy (PMBC) and surgery are also discussed. New data on long-term follow-up after PMBC is also presented. For severe rheumatic MS, medical therapy is ineffective and definitive therapy entails PMBC in patients with suitable morphological mitral valve (MV) characteristics, or surgery. As procedural outcomes depend heavily on appropriate case selection, definitive imaging and interpretation are crucial. It is also important to understand the indications as well as morphological MV characteristics to identify the appropriate treatment with PMBC or surgery.
Authors: Mahesh K Vidula; Ziqian Xu; Yuanwei Xu; Abdullah Alturki; Bhavana N Reddy; Prayaag Kini; Angel L Alberto-Delgado; Ron Jacob; Tiffany Chen; Victor A Ferrari; Lilia M Sierra-Galan; Yucheng Chen; Sanjaya Viswamitra; Yuchi Han Journal: J Cardiovasc Magn Reson Date: 2022-04-07 Impact factor: 6.903
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