Congenital Mitral Stenosis

Children with severe Congenital mitral stenosis pose a difficult surgical and medical management problem. The frequent occurrence of additional left-sided obstructive disease and intracardiac shunts favors a staged approach to management, involving both surgical and transcatheter interven- 

We have reported the effect of inhaled nitric oxide in 10 patients (median age, 3.3 years range, 0.4-11.1 years) with symptomatic congenital mitral stenosis.These studies were performed during interventional cardiac catheterization or after surgery requiring the use of cardiopulmonary bypass. Six patients had additional left ventricular outflow tract obstruction (median, 25 mm Hg range, 15-50 mm Hg). Effective relief of the mitral gradient was present after intervention. 

8 U m ). There was a decrease in mean systemic blood pressure from 73 16 to 68 14 mm Hg, which was without clinical consequence. 

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Mitral stenosis is seen typically as a consequence of chronic rheumatic fever. Isolated congenital mitral stenosis is very rare and not suitable for balloon valvuloplasty. Clinical symptoms depend on the degree of obstruction. Dyspnea, atrial fibrillation, embolic events, pulmonary edema, and right heart decompensation may occur and are all indications for treatment. Surgery and catheter intervention provide similar results. Balloon valvuloplasty produces best results in patients with little or no calcification of the mitral leaflets (20—23). 

Atz, A., Adatia, I., Moore, P., Jonas, R., and Wessel, D. (1994). Inhaled nitric oxide in congenital mitral stenosis with pulmonary hypertension. Pediatr. Res. 35, 29A... 

ECHO remains the procedure of choice in the diagnosis and evaluation of a number of conditions such as valvular dysfunction (aortic and mitral stenosis and regurgitation and endocarditis), wall motion abnormalities associated with ischemia, and congenital abnormalities, such as ventricular or atrial septal defects. Images obtained from ECHO are used to estimate chamber wall thickness and left ventricle ejection fraction, assess ventricular function, and detect abnormalities of the pericardium such as effusions or thickening. 

There also has been an explosion of therapeutic possibilities both medical and surgical. Witness the growth of closed heart surgery from closure of a patent ductus arteriosus and repair of coarctation of the aorta and mitral valvulotomy, profound hypothermia for atrial septal defect closure and pulmonary stenosis, open heart surgery, with cross-circulation and later extracorporeal circulation for valve repair and replacement, repair of complex congenital malformations and coronary artery bypass surgery and more recently the development of less invas-... 

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