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Acquired Mitral Stenosis Follow-up

  • Author: M Silvana Horenstein, MD; Chief Editor: Stuart Berger, MD  more...
 
Updated: Apr 29, 2014
 

Further Outpatient Care

Follow-up visits to the pediatrician and/or generalist are needed to monitor general health status.

Follow-up clinical visits to the pediatric cardiologist are needed to monitor antiarrhythmic drug levels and anticoagulation drug effectiveness by measuring prothrombin time (PT) and/or international normalized ratio (INR).

Serial echocardiography is indicated to monitor progression of mitral stenosis (MS). The frequency of these studies varies according to the patient's general health status and according to the cardiologist's criteria. Stress echocardiography may provide additional hemodynamic information.

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Further Inpatient Care

Intravenous diuretics may be used in patients with severe or refractory symptoms.

Oxygen administration or endotracheal intubation and mechanical ventilation may be necessary in patients with respiratory compromise due to pulmonary edema.

Patients with unstable tachyarrhythmias should undergo direct current (DC) cardioversion. Medical cardioversion can be attempted in patients who are hemodynamically stable. Echocardiography must be accomplished prior to cardioversion in order to assess the left atrium and its appendage for thrombi.

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Deterrence/Prevention

Antibiotics for endocarditis prophylaxis are required for patients with certain cardiac conditions, such as MS, before performing procedures that may cause bacteremia. For more information, see the American Heart Association's Webpage on infective endocarditis.

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Patient Education

Counsel patients and their families should be counseled regarding the appearance and/or worsening of symptoms.

Patients must follow American Heart Association infective endocarditis prophylaxis guidelines, and they should refrain from strenuous exercise.

Women should avoid taking warfarin during pregnancy. If MS is more severe than mild, strenuous activity and excessive salt intake are also contraindicated during pregnancy.

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Contributor Information and Disclosures
Author

M Silvana Horenstein, MD Assistant Professor, Department of Pediatrics, University of Texas Medical School at Houston; Medical Doctor Consultant, Legacy Department, Best Doctors, Inc

M Silvana Horenstein, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Henry Walters, III, MD Associate Professor of Surgery, Wayne State University School of Medicine; Chief, Department of Surgery, Division of Cardiovascular Surgery, Children's Hospital of Michigan

Henry Walters, III, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American Medical Association, International Society for Heart and Lung Transplantation, Phi Beta Kappa, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Michael D Pettersen, MD Consulting Staff, Rocky Mountain Pediatric Cardiology, Pediatrix Medical Group

Michael D Pettersen, MD is a member of the following medical societies: American Society of Echocardiography

Disclosure: Received income in an amount equal to or greater than $250 from: Fuji Medical Imaging.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Autonomic Society, American Physiological Society

Disclosure: Received grant/research funds from Lundbeck Pharmaceuticals for none.

Chief Editor

Stuart Berger, MD Medical Director of The Heart Center, Children's Hospital of Wisconsin; Associate Professor, Department of Pediatrics, Section of Pediatric Cardiology, Medical College of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

Ira H Gessner, MD Professor Emeritus, Pediatric Cardiology, University of Florida College of Medicine

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

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Hemodynamic changes in severe mitral valve stenosis (MS). MS causes an obstruction (in diastole) to blood flow from the left atrium (LA) to the left ventricle (LV). Increased LA pressures are transmitted retrograde to pulmonary veins and pulmonary capillaries, resulting in capillary leak with subsequent development of pulmonary edema. To overcome pulmonary edema, the arterioles constrict, increasing pulmonary pressures. Over time, capillaries develop intimal thickening, causing fixed (permanent) pulmonary hypertension. The right ventricle (RV) hypertrophies to generate enough pressure to overcome the increased afterload. Eventually, the RV fails, which manifests as hepatomegaly and/or ascites, edema of the extremities, and cardiomegaly on radiography.
 
 
 
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