Mitral Valve Stenosis

Overview

What is mitral valve stenosis?

Mitral valve stenosis is a heart condition in which the mitral valve fails to open as wide as it should. Although it has no immediate effect on health, eventually mitral valve stenosis can cause irregular heartbeats and possibly heart failure or other complications, including stroke, heart infection, pulmonary edema, and blood clots.

See an illustration of an open and closed mitral valve.

What is the purpose of the mitral valve?

The mitral valve is one of four valves in the heart. It regulates blood flow from the left atrium into the left ventricle, the heart's main pumping chamber. A normal mitral valve has two flaps, or leaflets. When the heart pumps, blood forces the flaps open, and blood flows from the left atrium (upper chamber) to the left ventricle (lower chamber). Between heartbeats, the leaflets close tightly so that blood does not leak backwards through the valve.

However, with mitral valve stenosis, the two leaflets and related structures become stiff, scarred, or partially fused together. As a result, the mitral valve gradually narrows, restricting blood flow to the left ventricle, increasing the volume and pressure of blood in the left atrium, and causing blood to back up into the lungs.

See an illustration of the heart and its chambers, valves, and blood flow.

See an illustration of mitral valve stenosis.

What causes mitral valve stenosis?

Virtually all cases of mitral valve stenosis are caused by rheumatic fever, which can follow an untreated strep throat infection. However, many people who have mitral valve stenosis don't realize they had rheumatic fever.¹

What are the symptoms?

Although mitral valve stenosis is a lifelong disease, symptoms usually do not develop for 10 to 20 years and may take as long as 40 years.^{1, 2} Early symptoms, such as shortness of breath with exertion, are often mild and hard to distinguish from normal breathing during exercise. Symptoms may not be noticeably abnormal until late in the disease.

In the later stages of mitral valve stenosis, the left atrium may not be able to keep pumping the same volume of blood into the left ventricle. Blood will begin to back up into the lungs, causing symptoms such as shortness of breath at rest or with only mild-to-moderate exertion, fatigue, weakness, and pounding of the heart.

How is mitral valve stenosis diagnosed?

Because early symptoms may be mild or unnoticeable, mitral valve stenosis may not be diagnosed in its early stages.

A review of your medical history and a physical examination will help your doctor determine how seriously your mitral valve is affected. To help check it, your doctor may order one or more of the following tests:

• An electrocardiogram, a test that measures the electrical signals that control the rhythm of your heartbeat
• An echocardiogram, which is an ultrasound examination used to study the heart
• A chest X-ray

How is it treated?

You and your doctor will need to decide whether to monitor the condition of your valve or fix it immediately. If you have stable mitral valve stenosis, or if you have no symptoms or mild symptoms, your doctor will likely monitor the progress of the stenosis and try to prevent complications in your heart or lungs.

If you have severe mitral valve stenosis or extensive heart damage that will likely get worse, your doctor will probably advise you to fix the valve, either with a balloon valvotomy, which stretches the valve open, or by having surgery to repair or replace the valve.

Your doctor may also prescribe medications to reduce symptoms or treat underlying or related conditions, such as abnormal heartbeats, blood clots, or heart failure.

Frequently Asked Questions

Cause

Virtually all cases of mitral valve stenosis are caused by rheumatic fever, which can follow an untreated strep throat infection. However, many people who have mitral valve stenosis don't realize they once had rheumatic fever.¹

In recent decades, cases of rheumatic fever have decreased considerably in Canada, the United States, and western Europe. However, many people throughout the world still get rheumatic fever; this may include immigrants from regions where rheumatic fever is more common.

Other less common causes of mitral valve stenosis include:

• A congenital (from birth) heart defect that causes mitral valve stenosis in infants and young children.

• Infection of the mitral valve or the adjacent heart muscle (infective endocarditis).
• Metabolic disorders, such as Fabry's disease or Hurler-Scheie syndrome.
• Hardening of the mitral valve components (annulus and leaflets) due to aging.
• Conditions that cause scarring of the mitral valve (lupus, rheumatoid arthritis, carcinoid syndrome).
• A noncancerous tumor in the left atrium (myxoma), which can also block blood flow across the mitral valve.

Symptoms

Although mitral valve stenosis is a lifelong disease, symptoms usually take 10 to 20 years to develop and can take as long as 40 years.¹ Early symptoms are often mild and hard to distinguish from other forms of heart disease.

In the later stages of mitral valve stenosis, the left atrium may become damaged, causing more noticeable symptoms.

You may not have any symptoms until an aggravating event—such as exercise, stress, pregnancy, infection, or an irregular heartbeat—occurs. Or you may have only a few symptoms, regardless of how far the stenosis has progressed. It is important that your doctor monitor your condition for physical changes in your heart and lungs that you might not be aware of.

Additional symptoms of mitral valve stenosis are related to developing heart failure and include an irregular heart rhythm (most often due to atrial fibrillation).

Other less common symptoms include:

• Hoarseness and vocal cord paralysis (Ortner's syndrome).
• Difficulty swallowing (dysphagia).
• Chest pain.
• Skin color changes, such as pink to purple shades of the cheeks (mitral facies) or dark bluish hues in various areas of the body due to reduced blood flow (cyanosis). Skin color changes occur rarely and usually only in the end stages of the disease.

Because these symptoms could be caused by various heart and lung problems, it may be difficult at first to connect them to mitral valve stenosis.

Symptoms may not become severe for another 3 to 10 years after they first become noticeable. It is often the development of one or more complications of mitral valve stenosis that leads to its diagnosis.

What Increases Your Risk

The three main risk factors for mitral valve stenosis are:

• History of rheumatic fever. Unfortunately, since most individuals do not know they had rheumatic fever, they may not know they are at risk.
• Aging. Wear and tear of the mitral valve over time may cause it to harden and narrow.
• Gender. About twice as many women as men develop mitral valve stenosis.³

Less commonly, diabetes and Marfan's syndrome can lead to mitral valve stenosis, causing calcification, or hardening, of the mitral valve's base. This limits the valve's flexibility and slows its rhythmic movements. However, these conditions usually increase the likelihood of mitral valve regurgitation rather than stenosis.

Any condition that scars the valves, such as endocarditis, may lead to mitral valve stenosis.

Little can be done to prevent mitral valve stenosis. Similarly, once you develop the condition, you cannot prevent the onset of symptoms or predict how quickly they will develop.

Fortunately, mitral valve stenosis can be treated, and few people die from it.

When to Call a Doctor

Call 911 or other emergency services immediately if you have:

• Symptoms of a heart attack, including severe chest pain.
• Symptoms of stroke or transient ischemic attack (TIA).
• Irregular heartbeats and are having fainting episodes or lightheadedness.
• Palpitations or shortness of breath or are coughing up blood.

Call a doctor immediately if you have:

• Symptoms of heart failure, such as shortness of breath, swelling in the feet and ankles, and dizziness, fainting, fatigue, or weakness.
• Mitral valve stenosis and are having symptoms of infection, such as fever with no other obvious cause. Be alert for signs of infection if you have recently have had any dental, diagnostic, or surgical procedure.
• Fainting episodes.
• A decreased ability to exercise at your usual level.
• Excessive fatigue without another explanation.

Watchful waiting

Episodes of chest pain or palpitations may come and go and may not be associated with other serious heart disease. However, contact your health professional when:

• Symptoms worsen.
• Symptoms persist longer than usual.

Who to see

Health professionals who can evaluate symptoms and order further tests as needed include:

• Family medicine physicians.
• Internists.
• Nurse practitioners.
• Physician assistants.
• Cardiologists.

These health professionals can provide management and monitoring. If you have severe mitral valve stenosis, you should see a cardiologist.

A cardiovascular surgeon may perform surgical repair of heart valves.

Exams and Tests

Mitral valve stenosis is a "quiet" condition—it often has no symptoms in its early stages and may not be diagnosed until you've had the disease for some time. If you are not having symptoms, such as shortness of breath or pounding of the heart, the first indication of mitral valve stenosis could be a suspicious heart murmur your doctor hears during a routine checkup.

Medical history and physical examination

A review of your medical history and a physical examination can predict whether you have mitral valve stenosis and help determine future treatment. Your doctor will ask about your lifestyle, activity level, and any conditions that you or any of your immediate family members have had. Your doctor will want to know about any symptoms you are having and if you have ever had:

• Rheumatic fever, an infection caused by an untreated strep throat infection.
• Endocarditis, an infection of the lining of the heart's valves and chambers.
• A congenital heart defect, which is a structural heart problem or abnormality present since birth.
• Atrial fibrillation, a persistent irregular heartbeat.
• Symptoms of heart failure, such as shortness of breath, swelling in the feet and ankles, and dizziness, fainting, fatigue, or weakness.

During the physical exam, the doctor will take your blood pressure, check your pulses, listen to your heart (possibly while you are lying on your left side) and lungs, and look for signs of fluid buildup (edema). Findings that may indicate a problem with your heart or heart valves include:

• A distinctive heart murmur—heard best while lying on your left side—and a specific extra heart sound, called an opening snap. These characteristic sounds can be easily missed or attributed to other heart or lung conditions, especially in people who are older, overweight, or have preexisting heart conditions.
• Swelling, especially in the legs, ankles, and feet, due to fluid buildup in the body (edema).
• Bulging neck veins caused by a backup of blood outside the heart.
• Fine crackles heard in the lungs, which are evidence of fluid buildup in the lungs.
• In severe cases, redness or flushing of the cheek area (mitral facies), especially in people who have fair complexions.

Echocardiogram

An echocardiogram is used to determine whether mitral valve stenosis is present and to estimate its severity. Echocardiography uses high-pitched sound waves to produce an image of the heart. Specifically, an echocardiogram can show structural problems of the heart that may affect the mitral valve.

Transesophageal echocardiography is often used in people when evaluating the heart through a thick chest wall is difficult. For this procedure, a device that uses ultrasound waves to produce an image of the heart is inserted through the mouth and down the throat into the esophagus. This test is often used—at the end of a mitral valve surgery, before the surgeon closes the incision—to see whether the valve is working properly.

Echocardiography should be considered if the doctor suspects mitral valve stenosis, whether or not symptoms are present, or if you have associated conditions such as heart failure or atrial fibrillation.

Your doctor can use an echocardiogram to:

• View the mitral valve opening and closing.
• Measure the size of the valve opening. A normal mitral valve opens between 4.0 and 5.0 cm². Technically, stenosis is present when the valve area is less than 4.0 cm². Symptoms do not usually develop until the mitral valve opens less than 2 cm², and no intervention is usually required until it is less than 1.0 to 1.5 cm².²
• Indirectly measure the pressure on the valve to determine the severity of mitral valve stenosis.
• View the general appearance and function of the left ventricle, the heart's main pumping chamber.
• Assess how much the leaflets of the mitral valve are damaged.
• Estimate the blood pressure in the pulmonary arteries.
• Assess the condition of the other heart valves.
• Measure the size of the left atrium.

In addition, an echocardiogram may help your doctor monitor any changes in your condition, especially if you have new or progressive symptoms of mitral valve stenosis. An echocardiogram can also help determine whether other heart conditions are also present, such as mitral valve regurgitation or aortic valve regurgitation.

Electrocardiogram

Electrocardiogram is used to measure the electrical activity in the heart by attaching small metal discs called electrodes to the chest, arms, and legs. The electrodes are also connected to a machine that translates the electrical activity into line tracings on paper. These tracings are often analyzed by the machine and then carefully reviewed by a doctor for abnormalities. This test is usually part of the standard evaluation of a person with symptoms of mitral valve stenosis.

An electrocardiogram (EKG or ECG) can:

• Verify how your heart is beating and whether it is in normal sinus rhythm.
• Help determine whether the heart chambers are enlarged.
• Screen for evidence of heart attack or poor blood flow to the heart (ischemia).

Chest X-ray

A chest X-ray may show evidence of mitral valve stenosis, such as enlargement of the upper left heart chamber (left atrium), enlargement of the pulmonary arteries, and too much blood and backup of fluid in the lungs (pulmonary edema). Calcium deposits on the heart valves occasionally may be seen on a chest X-ray, especially if the buildup is severe.

An EKG and chest X-ray find evidence of mitral valve stenosis only if it has caused other problems. These include enlargement of the heart (dilation), a thickened heart muscle (hypertrophy), an abnormal left atrium, an irregular heartbeat (arrhythmia), or an insufficient blood flow to the heart (ischemia).

Cardiac catheterization

Cardiac catheterization is usually done before any surgery for mitral valve stenosis to evaluate your heart, the degree of stenosis, and the heart (coronary) arteries. During a cardiac catheterization, the pressure in the heart chamber above the mitral valve (left atrium) is compared to the pressure in the chamber of the heart below the mitral valve (left ventricle). A large pressure buildup in the left atrium confirms the diagnosis of mitral valve stenosis and helps determine how severe it is.

This test may be needed when results of echocardiography are inconclusive or inconsistent with your symptoms. It can also identify other heart conditions that may cause symptoms similar to mitral valve stenosis. For example, it can evaluate the coronary arteries and check for coronary artery disease. Knowing the condition of the coronary arteries may affect later treatment decisions for mitral valve stenosis.

Treatment Overview

Key points

Treatment of mitral valve stenosis depends on the severity of your symptoms, which can take 10 to 40 years to develop. If you haven't yet developed symptoms or you have mild, stable symptoms, your doctor may only monitor your condition with periodic echocardiograms. As the valve narrows, symptoms will develop or get worse. Repair or replacement of the valve will be necessary to prevent complications such as heart failure.

As you review your treatment options, consider the following:

• Monitoring your condition may be all that's necessary before you develop symptoms or if you have only mild, stable symptoms.
• After symptoms develop, your doctor may prescribe medications to treat them and to prevent complications.
• During monitoring, if your doctor detects increased pressure in your heart and lungs, increased narrowing of the valve, or if your symptoms become severe, your mitral valve will need to be repaired or replaced.
• Whether your valve can be repaired or replaced depends on the condition of the valve. If it is damaged beyond repair, it will need to be replaced with an artificial valve.
• Repair can be noninvasive (balloon valvotomy) or require open-heart surgery (open commissurotomy). Replacement requires open-heart surgery.

Initial treatment

Mitral valve stenosis develops slowly. As the valve narrows, the heart initially compensates by pumping harder. Eventually pressure builds in the upper left side of your heart (left atrium) as more and more force is needed to push blood across your narrowing mitral valve. This eventually stretches the atrium's walls, weakens the heart, and leads to heart failure. For most people, it takes 10 to 20 years for the mitral valve to narrow enough to produce symptoms. This is called the asymptomatic phase. But if your heart adjusts to the narrowed valve, you may not have symptoms even after your valve has narrowed.

Symptoms most commonly develop when unusual stress places an extra burden on your heart. For example, symptoms in women often develop during pregnancy because of the increased demands it makes on the heart.

Ongoing treatment

Your doctor may prescribe medications to manage any symptoms of mitral valve stenosis you've developed, such as shortness of breath, and to prevent and treat complications that may develop. These may include:

• Diuretics ("water pills"), which reduce fluid retention and related swelling and which may also lower blood pressure in the upper left heart chamber (left atrium) and relieve breathing difficulties.
• Antiarrhythmics such as digoxin, beta-blockers, or calcium channel blockers, to slow and regulate an irregular and sometimes rapid heartbeat (atrial fibrillation).
• Anticoagulants, such as Coumadin, for atrial fibrillation.

Treatment if the condition gets worse

As your mitral valve stenosis gets worse, there will come a time when your doctor will advise repairing or replacing your mitral valve.

Mitral valve repair may be done in one of two ways:

• Balloon valvotomy. A thin flexible tube (catheter) is inserted through an artery in the groin or arm and threaded into the heart. Once the tube reaches the narrowed mitral valve, a balloon located on the tip of the catheter is quickly inflated. The balloon, pressing against the narrowed mitral valve leaflets, separates and stretches the valve opening and allows more blood to flow through the heart. This procedure does not require open-heart surgery, which makes recovery easier.
• Open commissurotomy. This method of repair requires open-heart surgery. A surgeon removes calcium deposits and other scar tissue from the mitral valve leaflets, which opens the valve. This procedure is used for people who have severe narrowing of the valve and are not good candidates for balloon valvotomy.

Mitral valve replacement surgery is also an open-heart procedure. The damaged heart valve is removed and replaced with a new valve. It is generally the last choice in mitral valve stenosis treatment because an artificial mitral valve cannot work as well as a normal mitral valve.

Your doctor will likely recommend valve replacement if the valve has deteriorated to the point that repair is not an option or if the anatomy of the valve has been changed by one or more repair procedures and can no longer be repaired.

See an illustration of mitral valve replacement surgery.

If you have an artificial valve, getting an infection in your heart (endocarditis) could be very dangerous for you. To prevent an infection, you may need to take antibiotics before you have certain dental or surgical procedures.

Ongoing Concerns

After you develop symptoms of mitral valve stenosis, it usually takes about 3 to 10 years before they become disabling. As long as your symptoms are mild or stable, your doctor may be able to keep them under control with medications. As your symptoms and the narrowing in the valve increase, surgery to repair or replace the valve will become necessary.

Complications

Although mitral valve stenosis can be an easy condition to overlook in its mild form, as it progresses it often has serious complications. The most common complications are an irregular heartbeat (arrhythmia), heart failure, and an infection in the heart (endocarditis). All of these are serious medical conditions that require treatment, and you and your doctor should discuss the most appropriate ways to prevent and treat them.

For more information, see the topics Heart Failure, Atrial Fibrillation, and Endocarditis.

Living With Mitral Valve Stenosis

Serious heart damage can result from long-term mitral valve stenosis. If you have been diagnosed with the condition, it is important to talk to your doctor about how often you should be examined.

Symptoms

Be especially alert for new or worsening symptoms, such as shortness of breath, pounding of the heart, or unusual fatigue. If new symptoms develop or preexisting symptoms become worse, call your doctor.

Exercise

People who have severe mitral valve stenosis may need to be cautious about their level of physical activity. If you don't exercise, talk to your doctor before you start. You may be able to do certain types of exercise that don't put undue strain on your heart.

If you don't have symptoms, discuss exercise with your doctor. If your stenosis is mild, normal activities, mild exercise, and in some cases competitive sports may be allowed. However, if your stenosis is moderate or severe and you have symptoms, you should avoid strenuous activity.

If you have a physically demanding job, you may need to change careers. Talk with your doctor to determine a safe level of activity.

Diet

Depending on the severity of your condition and symptoms, your doctor may advise you to limit salt in your diet to less than 2,300 mg a day. If you consume too much sodium, it will cause your body to retain excess fluid. Excess fluid in the body will cause swelling, breathing difficulties, fatigue, and other unpleasant side effects.

Salt restriction usually includes avoiding potato chips, pretzels, salted nuts, processed meats and cheeses, pizza, canned soups, canned vegetables, olives, fast foods, and frozen dinners (unless the label clearly states the product is low-sodium). Add more fresh fruit and vegetables to your diet to replace foods high in sodium.

When grocery shopping, check labels carefully for hidden sodium.

Antibiotics

Mitral valve stenosis puts you at risk for an infection in your heart (endocarditis), because blood does not flow normally. So bacteria or fungi may attach to heart tissue and cause an infection. Before you have any dental work or surgery (which could put bacteria or fungi into your blood), tell everyone who will treat you that you are at risk for endocarditis.

If you have an artificial valve, getting endocarditis is even more dangerous for you. So your doctor may prescribe antibiotics before you have certain dental or surgical procedures.

Medications

Medications are often used to relieve the symptoms and prevent complications of mitral valve stenosis. Usually they are also prescribed after surgery to repair or replace your mitral valve.

Diuretics ("water pills") are usually prescribed to reduce fluid retention and related swelling. They may also lower blood pressure in the upper left heart chamber (left atrium) and relieve breathing difficulties.

Complications of mitral valve stenosis that may be treated with medications include:

• Irregular heartbeats.Digoxin, beta-blockers, calcium channel blockers, and other antiarrhythmics may often be used to slow and regulate an irregular and sometimes rapid heartbeat (atrial fibrillation). Anticoagulants, which are often called blood thinners, are used to reduce the risk of stroke in atrial fibrillation.
• Infections.Antibiotics can help prevent heart infection (endocarditis), which is especially important in people who have an artificial heart valve. Antibiotics are recommended after surgery to repair or replace a valve and before certain dental and surgical procedures. And they may also help prevent a recurrence of rheumatic fever.
• Blood clots.Anticoagulants can lower a person's risk of stroke by preventing the formation of potentially harmful blood clots. They are needed after surgery to repair or replace a valve, or to prevent a stroke.
• Heart failure.Diuretics and angiotensin-converting enzyme (ACE) inhibitors help lower blood pressure, reduce fluid accumulation in the lungs, and therefore ease strain on the heart. Digoxin is used to slow a rapid and irregular heartbeat; it also increases the heart's ability to contract, which can increase cardiac output. Used with caution, beta-blockers may be given to ease the heart's workload by reducing the amount of blood the heart needs and by slowing the heart rate, which allows more time for blood to pass through the narrowed mitral valve.

What to think about

Talk with your doctor about the need for medications. If you have used the now-banned weight-loss medication fen-phen, there may be specific concerns about your heart valves.

Surgery

If medications are not effective in controlling your symptoms of mitral valve stenosis or if your doctor determines that you need more aggressive treatment, you may need surgery to repair or replace your mitral valve. While valve surgery is common and usually successful, a degree of risk is associated with this invasive procedure. There are generally three options: a balloon valvotomy, a closed (or open) commissurotomy surgery, or valve replacement surgery.

Valve repair (balloon valvotomy)

Balloon valvotomy (percutaneous mitral balloon valvotomy) is the method of choice for treating mitral valve stenosis in select patients. A thin flexible tube (catheter) is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon located on the tip of the catheter is quickly inflated. The balloon, pressing against the narrowed mitral valve leaflets, separates and stretches the valve opening and allows more blood to flow through the heart. This procedure does not require open-heart surgery, which makes recovery easier.

A balloon valvotomy is usually recommended if you have symptoms and moderate to severe stenosis.²

Your doctor will measure your pressure gradient and valve size to determine the severity of the stenosis. A normal mitral valve has an opening between 4 and 5 cm².

A balloon valvotomy may also be used to treat people with mitral valve stenosis who do not yet have symptoms (asymptomatic) if they have:⁴

• An increased risk of dangerous blood clots (thromboembolism). This includes people with an irregular heart rhythm called atrial fibrillation, as well as those who have had a blood clot before.
• High blood pressure in the lungs (pulmonary hypertension).
• A need for surgery outside of the heart as well.
• Plans to become pregnant or are pregnant.
• Mitral valves that are still in fairly good condition.

People with signs of blood clots in the left atrium, widespread calcification of the mitral valve structures, or moderate to severe mitral valve regurgitation are not considered good candidates for a balloon valvotomy.²

The mitral valve may narrow again (restenosis) after 10 to 20 years.

Valve surgery (open heart)

Depending on the amount of damage to your mitral valve, your doctor may recommend open-heart surgery to repair or replace your mitral valve. If the valve is damaged beyond repair, it will need to be replaced.

During open-heart surgery, your heartbeat is stopped, and you are placed on a heart-lung machine to deliver blood to your body. The heart-lung machine temporarily serves in place of your heart and lungs by mixing oxygen with the blood, removing carbon dioxide from the blood, and pumping the blood throughout your body.

Valve repair

In open commissurotomy, a surgeon removes calcium deposits and other scar tissue from the mitral valve leaflets, which opens the valve. This procedure is used for people who have severe narrowing of the valve and are not good candidates for balloon valvotomy.

Valve replacement

The damaged heart valve is removed and replaced with a new valve. This is generally done when your mitral valve is damaged beyond repair. With improved technology, mitral valve replacement is becoming an important surgical option. Some doctors believe that replacement mitral valves are now more durable. In addition, more of the original mitral valve and its support structure (such as the chordae tendineae) are preserved during valve replacement. The long-term results of surgery are generally better when more of the original mitral valve structure is preserved.⁵

If you have an artificial valve, getting an infection in your heart (endocarditis) could be very dangerous for you. To prevent an infection, you may need to take antibiotics before you have certain dental or surgical procedures.

Replacement heart valves

There are two types of replacement valves:

• A mechanical heart valve is made from plastic or metal. It is more likely to cause blood clots in the heart that can travel to the brain and cause a stroke. Because of this danger, people who have a mechanical heart valve must take anticoagulant medication for the rest of their lives. This medication prevents blood clots from forming.
• A bioprosthetic heart valve is made from human or animal (usually pig) tissue. In most people, it has the advantage of not requiring medication to prevent blood clots. However, bioprosthetic valves are not as sturdy as the mechanical valves. They usually need to be surgically replaced after about 10 years. Bioprosthetic valves are usually inserted in people older than 70.

Most people who have mitral valve replacement surgery will receive a mechanical heart valve. Even if a bioprosthetic tissue valve is used, you will need to take anticoagulants if you also have other heart conditions such as abnormal heartbeat (arrhythmia) or a dilated left atrium; both of these conditions are risk factors for stroke.

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Organizations

Related Information

• Atrial Fibrillation
• Endocarditis
• Heart Failure
• Mitral Valve Prolapse
• Mitral Valve Regurgitation