Acquired Mitral Stenosis Follow-up

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

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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