Treatment

The management of a patient with mitral stenosis includes the following:

• prevention of recurrent rheumatic fever:
  • penicillin is given for 5 years after the last attack of rheumatic fever or until the age of 20.
    
    
• anticoagulation:
  • this is to prevent thrombo-embolism.
  • some say should be started before the onset of atrial fibrillation.
    
    
• consider a beta-blocker for adults with moderate to severe mitral stenosis and heart failure (1)
  
  
• diuretics - lessen pulmonary venous pressure.
  
  
• balloon valvuloplasty:
  • best results are obtained when the valve shows commissural fusion, is pliable, is not heavily calcified, and has little or no disease of the subvalvular apparatus
    
    
• surgical mitral valvotomy or valve replacement

NICE state (1):

• consider transcatheter valvotomy for adults with rheumatic severe* mitral stenosis, if the valve is suitable for this procedure
• offer surgical mitral valve replacement to adults with rheumatic severe* mitral stenosis if transcatheter valvotomy is unsuitable

* severity of valve disease is defined in line with the British Society of Echocardiography guidelines on the British Heart Foundation's website.

Reference:

1. NICE (November 2021). Heart valve disease presenting in adults: investigation and management