1. Mitral valve Stenosis
*Read pages 1 – 9 in The Echocardiographer’s Pocket Reference; Read pages 259 – 262 and 277 – 286 in Otto; Read
Pages 185 – 190 in Echo Review Guide
*The mitral valve takes on a “hockey stick” appearance seen best in the
PLAX and Apical 4 windows(important to know)!

2. Pictures of Mitral stenosis

3. *Definition: A narrowing of the mitral valve orifice, which impedes the diastolic
flow into the LV from the LA
Rheumatic fever is the most common cause at approximately 99% of all cases
The principal, or most common, presenting symptom of mitral stenosis is
Dyspnea upon exertion(approx. 80% include this symptom)
Hemoptysis(coughing up of blood or blood in sputum) is the 2nd most common
symptom(approx. 30% include this symptom)
Chest pain is another symptom, but occurs at much lower rate of approx. 15%
Other findings include: palpitations, orthopnea(difficulty breathing while lying
Flat), Paroxsymal nocturnal dyspnea(attacks of severe shortness of breath and
coughing that occurs at night), fatigue, syncope and right heart failure.

4. A closer look at the most common causes of mitral stenosis……………
Dyspnea upon exertion is caused by the blood not being able to leave the LA.
This causes the blood to back up or not be able to enter the LA as easy.
Which in turn, causes the lungs to work harder to get rid of the oxygenated blood.
Ex. Trying to put more water in an already full water balloon
Hemoptysis is a result of the blood not having anywhere to go, so the body will
get rid of it the easiest way it can, which is through the lungs.

5. *Upon physical examination the patient will have:
A low normal BP, caused by all the pressure backing up into the lungs
Irregular pulse, caused by afib (a heart in afib doesn’t beat efficiently .
Patient can experience palpitations, which are sensations of a racing
Irregular HR. Patient can also experience weakness, lightheadedness,
CP or confusion.
Apical diastolic thrill, which is a vibration felt at the apical window.

6. *Complications that occur from mitral stenosis:
Mitral Regurgitation that occurs with mitral stenosis, which is
Simply caused by the MV not closing properly due to the
Valve being calcified.
Passive/reactive pulmonary hypertension (Passive PHTN is caused
By post-pulmonary capillary elevation associated with PCWP or
Pulmonary Capillary Wedge Pressures, this is measured by
Introducing a catheter into the distal Pulmonary Artery and a
Balloon is inflated. While the balloon is inflating, the pressure
Is measured, which is very close to the pressure of the LA.
Reactive PHTN is initially passive but the upstream vasculature
responds to chronic passive congestion by developing an
Active superimposed-on-passive component
Left atrial thrombus, which is more of a direct result from afib.
These are mostly found in the LAA or Left Atrial Appendage.
Embolization occurs approx. 20% of the time in patients without
afib and 80% of the time in patients with afib.

7. *Cardiac Auscultation:
Opening snap is a very important physical sign
Low pitched diastolic rumble, which is the murmur you would hear!

8. *Treatment for mitral stenosis:
Prophylactic antibiotic therapy(until age 40)
Anticoagulation and Diuretics
Mitral valve replacement

9. Mmode findings: Normal MV mmode Mitral stenosis mmode
Thickened MV leaflets
Decreased E-F slope
Anterior motion of the posterior MV leaflet

10. 2D findings Thickened MV leaflets Hockey stick appearance(see arrow),
which is diastolic “doming” of the anterior
MV leaflet
Commissural fusion, which means that
the MV leafleats are fused together
Left atrial dilatation
Spontaneous echo contrast(you can see
the blood flowing in the LA, which is also
called “smoke”(seen in second picture)

11. PW and CW Doppler Turbulent flow Increased MV E velocity
Decreased E-F slope of the MV inflow
*The more severe the mitral stenosis, the less steep the E-F slope

12. Color flow doppler Narrow “flame –shaped” jet
May form a PISA done on the atrial side
of the MV

13. Mitral stenosis severity scale
Pressure ½ time
Normal 30 to 60 msec
Abnormal 90 to 400 msec
Gray Area 60 to 90 msec
Mild 90 to 150 msec
Moderate 150 to 219 msec
Severe > 219 msec
Mitral valve area( 220/ P ½ time)
Normal 4 to 6 cm squared
Mild 1.5 to 2.5 cm squared
Moderate 1.0 to 1.5 cm squared
Severe < 1.0 cm squared
Mean pressure gradient
Mild < 6 mmHg
Moderate 6 to 12 mmHg
Severe > 12 mmHg