Rheumatic mitral stenosis. On the rise again

Rheumatic mitral stenosis remains an important cause of exertional dyspnea, pulmonary congestion, atrial fibrillation, and stroke. Detection rests on careful auscultatory examination and detailed review of chest films. Diagnosis is confirmed by echocardiographic examination; cardiac catheterization is important in symptomatic patients to evaluate the severity of stenosis and associated lesions. Treatment of pulmonary congestion and control of heart rate in patients with atrial fibrillation remain major medical goals. Percutaneous balloon commissurotomy is preferred for most patients with predominant mitral stenosis and for those with contraindications to valve replacement. Implantation of a prosthetic valve is best for patients with significant mitral regurgitation, multivalve disease, associated coronary artery disease that requires bypass, or mitral valve deformity too severe to allow adequate balloon commissurotomy.