Congenital Mitral Stenosis Follow-up
- Author: M Silvana Horenstein, MD; Chief Editor: Stuart Berger, MD more...
Further Outpatient Care
Regular visits to the pediatrician and/or generalist to monitor general health status, depending on the severity of the mitral stenosis (MS)
Regular visits to the pediatric cardiologist to monitor hemodynamic status, antiarrhythmic drug levels, and anticoagulation
Serial echocardiography to monitor anatomic and hemodynamic progression of the MS: The frequency varies according to the patient's general health status and according to the cardiologist's criteria.
Stress Doppler hemodynamics using a supine bicycle or treadmill: Hemodynamics may be measured using transthoracic echocardiographic Doppler. This noninvasive test has replaced the traditional exercise stress test in the catheterization laboratory.
Antibiotics for endocarditis prophylaxis are required for patients with certain cardiac conditions, such as mitral stenosis, before performing procedures that may cause bacteremia. For more information, see Antibiotic Prophylactic Regimens for Endocarditis.
Avoid excessive salt intake, which increases fluid retention and may worsen symptoms. Note the following:
Avoid excessive heat, excessive use of diuretics, and dehydration, which may decrease LV output by reducing preload.
Patients taking anticoagulants should avoid contact sports because of risks of cerebral, splenic, renal, or other internal organ bleeding. Pregnant women should avoid warfarin because of its teratogenic effects and risk of miscarriage.
Counsel the patient and families regarding the appearance and worsening of symptoms.
Prior to any invasive or surgical application, advise the patient regarding subacute bacterial endocarditis prophylaxis.
Monitor prothrombin time (PT) and international normalized ratio (INR) if the patient is on anticoagulation medication.
Advise pregnant mothers to avoid taking warfarin, avoid strenuous activity and excessive salt intake, and have their blood pressure frequently monitored.
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