Symptoms
Mitral stenosis usually from rheumatic carditis to the initial obvious symptoms of mitral stenosis can be up to 10 years; the next 10 to 20 years of gradual loss of mobility. 1. Dyspnea is the most difficult labor of early respiratory symptoms, mainly due to reduced lung compliance. With the course of development, and daily activities can be difficulty in breathing and orthopnea, when there is fatigue, agitation, respiratory tract infection, sexual intercourse, pregnancy, or atrial fibrillation and other incentives, it can induce acute pulmonary edema. 2. Cough and sleep more at night after work. Mostly dry cough; concurrent bronchitis or lung infection, cough or purulent sputum mucus samples. Significant expansion of left atrial pressure can also cause bronchial cough. 3. Hemoptysis or bloody sputum   bloody sputum, and bronchitis, lung infection, and pulmonary congestion, or broken capillaries on; often accompanied by paroxysmal nocturnal dyspnea; mitral stenosis and pulmonary embolism late bleeding, may also hemoptysis sputum;   massive hemoptysis, is due to a sudden increase in left atrial pressure, which cause bronchial variceal bleeding. More common in the early mitral stenosis, only mild or moderate in patients with elevated pulmonary artery.   pink foam sputum for broken capillaries caused by the characteristics of an acute pulmonary edema. 4. Chest pain about 15% of the performance of patients with mitral stenosis have chest pain may be due to hypertrophy of the right ventricular wall tension increased, while cardiac output caused by right ventricular ischemia caused decreased. The expansion of mitral valve surgery or after separation can be alleviated. 5. Thromboembolism in patients with mitral stenosis 20% of thromboembolism in the course of the disease, of which 80% had atrial fibrillation. Embolism can occur in the brain blood vessels, coronary and renal arteries, some patients may be repeated. Or embolism occurred. 6. Other symptoms of left atrial enlargement and expansion of the left pulmonary artery compression of the left recurrent laryngeal nerve can be caused hoarseness; left atrial pressure significantly increased to the esophagus, causing difficulty in swallowing; right ventricular failure can occur when the loss of appetite, abdominal distension, nausea and other symptoms. Features 1. Cardiac auscultation apex in the late diastolic rumbling low-key kind of noise, showing increasing type, limitations, left lateral position was obvious, may be associated with diastolic tremor. Apex hyperthyroidism first heart sound, were slap-like. In 80% to 85% of patients 3 to 4 left sternal border or apex medial intercostal news and mitral valve opening sound (openingsnap, os), followed by the sound after the second heart sound, high-profile short and loud, call gas was clearly, is the mouth of the main valve diaphragm type valve (mitral valve) tremor occurs in the open due to break on first heart sound samples and sound presence of mitral valve opening, highly suggestive of mitral stenosis and valve there is still some flexibility and activity, contribute to the diagnosis of mitral stenosis diaphragm type, method of determining the surgical treatment of certain significance. Because pulmonary hypertension, pulmonary valve can occur with hyperthyroidism and split second heart sound. Severe pulmonary hypertension, left sternal border in the first 2 to 4 intercostal smell and a high-profile, decreasing-based early and mid diastolic murmur, showed hair-like, along the left sternal border transmission to the tricuspid valve area, inspiratory time increased. This is because the expansion of pulmonary artery and valve ring, resulting in relative pulmonary valve regurgitation murmur (graham-settll noise). Systolic pulmonary valve can sometimes hear the sound of early clicks, this sounds obvious exhale, inhale reduced. Severe mitral stenosis, due to pulmonary hypertension, right ventricular enlargement, tricuspid valve ring caused by the expansion, resulting in relatively tricuspid regurgitation. Right ventricle through the tricuspid valve port when the part of the blood reflux into the right atrium, resulting in hair samples tricuspid systolic murmur the whole area to the apex conduction, inspiratory obvious. 2. Other signs of severe mitral valve face is seen in patients with mitral stenosis, due to reduced cardiac output, patients with two zygomatic was purple, lips slightly cyanotic. See also limb peripheral cyanosis. Mitral stenosis occurs in childhood, precordial bulge can be seen, the left nipple toward the upper left room, and lifting systolic left sternal border at the kind of beating, the heart in patients with moderate to severe stenosis in the left sternal border dullness third intercostal to the left to expand, said the increased pulmonary artery and right ventricle. JVP obvious, indicating the presence of severe pulmonary hypertension. Etiology and pathogenesis of soft normal mitral valve, mitral valve area of about 4 ~ 6cm2. When the valve area is reduced to 1.5 ~ 2.0cm2 when mild stenosis; 1.0 ~ 1.5cm2 when moderate stenosis; <1.0cm2 when severe stenosis; the main mitral stenosis pathophysiological changes after a diastolic blood When the left atrium into the left ventricle is limited, making the abnormal increase of left atrial pressure, left atrial and left ventricular pressure gradient between the increase in order to maintain normal cardiac output. Elevated left atrial pressure can cause pulmonary vein and pulmonary capillary pressure increased, and then expansion and congestion. At this time patients may be no obvious symptoms at rest, but in physical activity, because of faster blood flow, pulmonary venous and pulmonary capillary pressure increased further, immediate difficulties, coughing, cyanosis, or acute pulmonary edema. Long-term pulmonary blood volume overload can lead to pulmonary arterial pressure rise. Long-term pulmonary hypertension, the pulmonary artery spasm and hardening, and lead to right ventricular hypertrophy and expansion, followed by right ventricular failure may occur. At this time decreased pulmonary artery pressure, pulmonary blood flow decreased, pulmonary bleeding was defused. Pure mitral stenosis, left ventricular end-diastolic pressure and volume to normal. Most patients with mitral stenosis increased exercise left ventricular ejection fraction, end systolic volume reduction. About a quarter of mitral stenosis severe left ventricular dysfunction, manifested as ejection fraction and other indices of reduced systolic function, which may be the result of chronic preload reduction. Most patients with mitral stenosis at rest in the normal range of cardiac output during exercise the increase in cardiac output is lower than normal; a small number of severe stenosis in resting cardiac output is lower than normal cardiac output during exercise is not increase but decrease, mainly due to mitral stenosis in addition, there have been impaired left ventricular function. In addition, left atrial enlargement, difficult to maintain normal electrical activity of the heart, atrial fibrillation Guchang. Fast ventricular rate atrial fibrillation can increase pulmonary capillary pressure, increased pulmonary congestion or easily induced pulmonary edema. Pathological changes in the pathological changes and the first valve at the junction of the base of the formation of inflammatory edema and vegetation,
Because fibrosis and mitral stenosis (or) calcification, the leaflets broad thickening, adhesion, chordal fusion, shortening, stiff valve leaflets, leading to deformation and mitral valve stenosis, significant stenosis when a crack-like hole. By lesion type and funnel into the diaphragm. Diaphragm-type body of the main lobe lesions or disease-free mild activity can still; funnel valve leaflets thickened and fibrosis, chordae and papillary muscle adhesion and significantly shortened the valve was funnel-shaped hardened, activity was limited. Often accompanied by varying degrees of regurgitation. Further increase the narrow calcified valve leaflets, and can lead to thrombosis and embolism. Congenital mitral stenosis, thickening of the valve leaflets, the junction of fusion, chordal thickening or shortening, papillary muscle hypertrophy or fibrosis, can have a narrow ring on the flap, flap may have fiber belt. The most characteristic is that only a parachute mitral valve papillary muscle malformation, the two valve leaflets are connected to the tendons on the papillary muscle, plus the valve to open the parachute. Diagnosis of the earliest symptoms of the symptoms of paroxysmal nocturnal dyspnea, severe orthopnea; very severe cases can produce pulmonary edema, cough, cough pink foamy sputum, increased more after sleep or activity may be associated with sputum , bloody sputum, hemoptysis, with the progress of the disease, lower extremity edema, oliguria, then relieve breathing difficulties. Signs of mitral valve face, lips slightly cyanotic. Precordial bulge, apical diastolic fine tremor can be touched, the heart boundary in the third intercostal space to the left to expand. Apical s1 hyperthyroidism, was slap of the left sternal border   ~   intercostal to be heard on the apex and start shooting within the sound, if the elasticity of the valve leaflets lost s1 hyperthyroidism and open valve sound may disappear; apex could be heard and diastolic, the late noise like thunder, was incremental to left lateral position, breathing at the end and the noise is more obvious after the event; p2 pulmonary valve with split audio and hyperthyroidism; pulmonary valve area in the left sternal border   ~   intercostal short news splashing water like early diastolic murmur, (graham-steell noise) deep breathing strengthened. Laboratory examinations (a) X-ray examination of the earliest changes in the left atrium is left Xinyuan arc obvious, prominent main pulmonary artery, pulmonary vein widened, right anterior oblique perspective of barium can be seen in the left atrial pressure expansion of the esophagus. Severe lesions, the left atrium and right ventricle was significantly increased after the film showed anterior margin of the right heart shadow was a double shadow, hilar shadows deepened, smaller aortic arch. Left ventricle in general is not. When the left atrial pressure of 2.7kPa (20mmHg), the middle and lower lung shows KerleyB line. After long-term pulmonary congestion hemosiderin deposition, double lung field, there may be scattered under the point-like shadow. Elderly patients often have mitral valve calcification, and young adults are not rare.
Mitral stenosis (b) ECG ECG mild mitral stenosis may be normal. Characteristic change in the P wave broadening and bimodal shape, suggesting left atrial enlargement. Pulmonary hypertension, showing increased right ventricle, right axis deviation. Course of the disease is often associated with atrial fibrillation late. (C) echocardiography is the most sensitive and specific noninvasive diagnostic method for determining the valve area and transvalvular pressure gradient, to determine the extent of disease, surgical methods, and evaluation of the decision the efficacy of surgery are of great value. Visible on two-dimensional echocardiography before and after mitral valve leaf reflectance enhancement, thickening, activity rate decreased diastolic forward bulging of the anterior lobe was the body of the balloon-like, before and after the flap tip distance was significantly shorter leaves, open area is reduced . M-mode ultrasound shows diastolic filling rate decreased, the normal two peaks disappeared, E curve decreased slowly after peak, mitral valve, diastolic posterior lobe in the anterior lobe was subordinate to the same movement, the so-called battlements like change. Left atrial enlargement, right ventricular hypertrophy and right ventricular outflow tract widened. Doppler ultrasound showed a slow decreasing the blood flow through the mitral valve. Show diastolic mitral valve dome change, the left atrium and left ventricle increases. (D) radionuclide radionuclide blood pool imaging showed left atrial enlargement, imaging agents, and through the extended uptake, left ventricular little. Pulmonary hypertension, showing main pulmonary artery and right ventricular enlargement. (E) right heart catheterization right ventricle, pulmonary artery and pulmonary capillary pressure increased, pulmonary vascular resistance increases, cardiac output decreased. Atrial septal puncture can be determined directly after the left atrium and left atrial pressure, mitral valve stenosis in early diastolic pressure gradient across the normal, as the disease increased, the pressure gradient increases, the contraction of the left atrial pressure curve was a tall wave. Differential diagnosis that rumble like apex diastolic murmur and a left atrial enlargement, can be diagnosed mitral stenosis, echocardiography can confirm the diagnosis. Clinically, mitral stenosis with the following conditions should be the apex diastolic murmur identification: (a) the apex of acute rheumatic carditis with high-profile, soft early diastolic murmur, daily changes in the larger, rheumatism activity control, the noise can be disappear. This is because the ventricular enlargement, mitral stenosis due to the relative, the Carey-Coombs murmur. (B) "functional" mitral stenosis found in a variety of reasons due to left ventricular dilatation, mitral flow rate increases, or mitral valve in aortic regurgitation by diastolic blood of the impact of other circumstances, such as large left to right shunt and patent ductus arteriosus, ventricular septal defect, aortic valve insufficiency, etc., the noise lasted for a shorter, non-open valve sound, with the more gentle, amyl nitrite inhalation noise reduction, application of vasopressors After the noise intensified. (C) of the left atrial myxoma is the most common primary cardiac tumors are. Clinical symptoms and signs similar to mitral stenosis, but was intermittent, with the change of position, generally no open valve sound and can be heard tumor plop, atrial fibrillation, there is rarely easily understood phenomenon of repeated peripheral arterial embolism. Echocardiography showed systolic and diastolic mitral valve after a group were seen cloudy back sound waves. Cardiac catheterization showed significantly elevated left atrial pressure, selective angiography showed filling defect in left atrium. The latter has been less, because we have led off the possibility of tumor thrombus. (D) the lower left sternal border Tricuspid stenosis and heard the rumble of a low-key kind of diastolic murmur, inspiratory noise can increase due to change thy blood increased, decreased breath. Jugular vein during sinus rhythm a wave increases. Diastolic murmur in mitral stenosis apex, no change in inspiratory or weakened. Echocardiography can confirm the diagnosis. (E) of primary pulmonary hypertension occurred in female patients, no diastolic murmur apical area and open valve sound, not to expand the left atrium, pulmonary artery wedge pressure and left atrial operation pressure is normal. What should be done with mitral stenosis Check 1. Echocardiography (UCG) UCG diagnosis of mitral stenosis have a higher specificity, in addition to determining the presence of mitral stenosis and valve area, the can still help understanding of cardiac shape and determine the extent of valvular lesions and surgical decision on the changes observed before and after surgery and postoperative recurrence of mitral stenosis, it is also of great value. 2.X-ray X ray findings and the degree of mitral stenosis and the stage of disease development. Mild mitral stenosis, the heart shadow may be normal. Moderate stenosis, can be found in the inspection increased the left atrium, pulmonary artery segment prominent elevation of left bronchus, and may have increased and so the right ventricle. Posteroanterior, such as the pear-shaped heart shadow, called the "Mitral-type heart", the aortic smaller; right anterior oblique barium swallow examination can be found in the left atrial pressure expansion of the esophagus, making it backward shift; left anterior oblique Parity easy to find the right ventricle increases. Mitral stenosis the pulmonary manifestations were pulmonary congestion, hilar shadow was deeper; the redistribution of pulmonary venous flow, often has the upper lung blood vessels increased while the lower shadow reduction; pulmonary lymphangiectasia in the post-anterior and left anterior oblique a common step down outside the chest and right lung near the costophrenic angle with horizontal direction of the linear shadow, that is, Kerley B lines; occasionally seen on the leaves from the lung hilum oblique to the direction of linear opacities, said Kerley A lines; In addition, Long-term results of pulmonary congestion in the lung field hemosiderin deposition seen in the point-like shadow 3. electrocardiogram mild mitral stenosis, ECG can be normal. And severe mitral stenosis, the first is a characteristic ECG changes of left atrial enlargement of the P wave, widening of the P wave and showed two peaks, called the mitral valve-type P wave (P  > 0.12 s, V1Ptf <-0.3mm · s, P axis is 45   ~ -30  ). With the progress of the disease, when involving the right heart with pulmonary hypertension, may have right axis deviation and right ventricular hypertrophy ECG. Arrhythmias are very common in patients with mitral stenosis, early can be expressed as atrial contraction, and more frequent source of atrial fibrillation is often a harbinger of contraction, significantly increased when the left atrial fibrillation often occur. 4. Cardiac catheterization diagnosis of a very few difficult cases, lines need to be considered before cardiac catheterization. The main cardiac catheterization showed right ventricle, pulmonary artery and pulmonary arterial wedge pressure increased, pulmonary vascular resistance increases, cardiac output decreased. The direct determination of atrial septal left atrial puncture, left ventricular pressure and transmitral pressure. 1 complication (a) arrhythmia in the most common atrial arrhythmia, atrial premature beat occurs first, after the atrial tachycardia, atrial flutter, paroxysmal atrial fibrillation until the persistent atrial fibrillation. Increased left atrial pressure and left atrial enlargement caused by rheumatoid inflammation in the left atrial wall fibrosis is the pathological basis of persistent atrial fibrillation. Atrial fibrillation reduces cardiac output and can precipitate or aggravate heart failure. Atrial fibrillation occurs, the apex of the systolic and diastolic rumbling murmur may disappear before the enhancement, rapid atrial fibrillation and diastolic rumbling murmur apex reduce or disappear, heart rate Shiyou obvious or appear. (B) congestive heart failure and acute pulmonary edema in 50% to 75% of the patients with congestive heart failure, mitral stenosis is a major cause of death. Respiratory tract infections are common causes of heart failure in patients with pregnancy and childbirth, women offenders are usually induced heart failure. Severe acute pulmonary edema is important complications of acute mitral stenosis, occurred in the intense physical activity, emotional excitement, infection, sudden tachycardia or atrial fibrillation, in the more easily induced when pregnancy and childbirth. The case was accelerated heart rate, left ventricular diastolic filling time shortened; pulmonary blood volume increased; left atrial pressure increased significantly, resulting in increased pulmonary capillary pressure, plasma leakage to the interstitial or alveolar, which led to acute pulmonary edema. (C) embolization of cerebral embolism the most common, can also occur in the limbs, intestine, kidney and spleen and other organs, emboli come from the expansion of the left atrial appendage and atrial fibrillation were. Sources of right atrial embolus can cause pulmonary embolism or pulmonary embolism. (D) of the patients with lung infection often increased pulmonary venous pressure and pulmonary congestion, easy to pulmonary infection. Infection often occurs after an absence of increased lung or induced heart failure. (E) sub-acute infective endocarditis is less common. Treatment (a) compensated appropriately to avoid excessive treatment manual and strenuous exercise, protect the heart function; of rheumatic heart disease patients should be actively prevent streptococcal infection and rheumatic activity, and infective endocarditis. (B) the treatment of decompensated clinical symptoms were advised to limit sodium intake of oral diuretics. There was right heart failure or atrial fibrillation, the use of digitalis preparations can relieve symptoms and control of ventricular rate. Persistent atrial fibrillation within one year, should be considered drugs or electrical cardioversion therapy. Those with heart failure and atrial fibrillation on long-term anticoagulation therapy can be used to prevent thrombosis and arterial embolism. Closure of the treatment is to relieve mitral stenosis, lower transvalvular pressure gradient. Often used in surgical methods are: 1. Percutaneous mitral balloon dissection. This is an interventional cardiac catheterization techniques, the indication is pure mitral stenosis. This method can be extended to 2.0cm2 mitral valve area of more than decreased mitral transvalvular pressure gradient and left atrial pressure, increased cardiac index, effectively improve the clinical symptoms. Percutaneous mitral balloon dissection flap without compromising the structure, operations experts were also to avoid complications; and without thoracotomy, more secure, the patient damage, quick recovery, curative effect has been affirmed. Introduction of percutaneous surgery for mitral surgery balloon angioplasty (percutaneousballoonmitralvalvuloplasty, PBMV) is the use of balloon dilation of the mechanical strength of the adhesion junction isolated mitral valve to relieve mitral valve stenosis. According to the different instruments used in the expansion can be divided into Inoue balloon method, polyethylene single balloon method, double balloon method and metal mechanical dilator method. Is widely used in clinical Inoue balloon method.
Mitral stenosis present, the most widely Inoue balloon method, accounting for about 90%, is the most commonly used technology. Since 1984, Japanese heart surgeon, Kanji Inoue (DR.KanjiInoue) Since the launching of the first clinical, the major medical institutions in the world rapidly expanded to become the interventional treatment of valvular heart disease one of the technologies most widely used. Currently, there are around 50,000 patients received the above treatment, patients are mainly concentrated in Asia, North America, Europe and other regions to China, India, Japan, the United States, France and other countries to carry out more. Since the launching of the technology since, technology development, from the form to the dilator catheter method has many innovations and improvements, until the current technology matured, several major developments are as follows: 1982 Inoue rubber nylon self-made First used in clinical single balloon dissection; the first publicly reported in 1984, modified Inoue balloon expansion after a group of cases; 1985 Lock method such as the use of polyethylene single-balloon success; 1986 AlZaibag such reports double-balloon successful application of the law the same year, reported by Babic atrial septal artery retrograde puncture of non-success; 1997 Cribier other metal mechanical dilator expansion of the success of mitral stenosis. Several advantages and disadvantages of current clinical methods are commonly used: 1.Inoue The main advantage of balloon method is simple, broad indications, the main deficiency is more expensive. 2. Polyethylene main advantage of double-balloon method to avoid a transient blood flow to stop the heart, the main drawback is complicated to operate. 3. The main advantage of mechanical expander method is reusable, low cost, the main drawback is that more complications. The past 20 years, applications to carry out PBMV Inoue balloon technique is widely available in China at present in many grass-roots hospitals have been widely carried out. More than 200 hospitals in accordance with national statistics, at present China has completed nearly 10,005 PBMV surgery more than a thousand patients, mostly with Inoue balloon technique, technical success rate remained stable at 95.2% ~ 99.3%, and serious complications control 1%, 3 to 5 years in 15% restenosis rate to 31% or so. Its non-invasive, fewer complications, welcomed by the majority of patients. China has more than 300 million patients with rheumatic mitral stenosis, much of it suitable for use treatment PBMV, its further spread is significant. At present, many domestic balloon has been put into use in the clinical results were satisfactory. Indications and contraindications Generally speaking, all patients with symptomatic mitral stenosis were PBMV indications. But combined with other circumstances as well as individuals to their own conditions and different valve conditions are different, the operation short and long term effects may be different, PBMV indications for surgery can be divided into good indication and relative indications. Mitral valve area ideal indication     1.5cm2, valve soft, no calcification, and subvalvular abnormalities (Wilkins ultrasound score <8min);   sinus rhythm, no history of circulation embolism;   no mitral valve regurgitation and other valve disease;   no rheumatic activity;   the age of 50 years of age;   clear clinical symptoms, cardiac function was NYHA   ~   grade. Relative indication of mitral valve area   1.5cm2, who combined the following conditions:   less flexible and mitral valve calcification, Wilkins ultrasound score> 8min, or those under fluoroscopic mitral valve calcification;   closed separation surgery restenosis after surgery or who PBMV;   combined with mild mitral regurgitation or aortic valve insufficiency;   transesophageal echocardiography in patients with atrial fibrillation confirmed that no left atrial thrombus (required anticoagulant treatment for 4 to 6 weeks);   combined ear only machine of the left atrium thrombus or no evidence of left atrial thrombus, but there is a history of circulation embolism (requires 4 to 6 weeks of anticoagulant therapy);   elderly patients (with coronary angiography);   Consolidated Interim pregnant patients;   patients with acute pulmonary edema;   combined with other available treatment for the purposes of intervention in patients with congenital cardiovascular malformations such as atrial septal defect, patent ductus arteriosus, pulmonary stenosis and pulmonary arteriovenous fistula;   combined with other non- surgical conditions for patients, such as cardiopulmonary disease such as poor or inoperable due to endotracheal anesthesia;   associated with other heart malformations heart at right place or who was scoliosis;   infective endocarditis have been cured, and by ultrasound echocardiography who confirmed that no valvular vegetations. Contraindications fresh   left atrial thrombosis;   who have active rheumatism;   uncontrolled infective endocarditis or other infectious diseases in patients with site;   merge more than moderate mitral regurgitation, aortic valve insufficiency and stenosis;   valve was extremely poor, combined subvalvular stenosis, Wilkins ultrasound score> 12 points were. Complications of cardiac perforation and (or) acute pericardial tamponade, mitral insufficiency, circulation embolism, atrial septal damage and caused atrial level shunt, arrhythmia, acute pulmonary edema (caused by long balloon mitral valve plug ), acute myocardial infarction, low cardiac output syndrome, infective endocarditis, femoral artery and vein damage. Clinical evaluation of palliative patients with mitral stenosis treated by disease, can delay the time of surgical valve replacement, quality of life for young patients is important; of patients with pregnancy in mitral stenosis, mitral stenosis poor lung function patients with mitral stenosis in patients with acute pulmonary edema caused by, can not tolerate surgery in elderly patients have special significance. In general, successful dilatation can maintain heart function in patients 2 to 10 years without any other special treatment,, PBMV 1 to 2 years after restenosis rate of 2% to 22%, and as time goes by , restenosis rate will continue to increase, 3 to 5 years up to 20% to 40%, 5 to 10 years up to 40% to 70%, valvular conditions are good for young patients, PBMV surgery can be implemented many times, so for valve time is greatly delayed, or even life without valve replacement; for disadvantaged older valve patients, PBMV valve replacement surgery generally delayed 2 to 5 years or even longer, from this point, which is far of efficacy is satisfactory. 2. Mitral valve surgery has closed and look isolated two. Closed to use more use of the left ventricle into the expansion of methods that the best effect on the diaphragm type. The indication for surgery in patients older than 55 years of age, heart function in 2 to 3, nearly half of the year without rheumatic activity or infective endocarditis, no preoperative atrial thrombus not associated with or only mild b mitral regurgitation or aortic valve disease and left ventricular little. With pregnancy and need surgery should be carried out within 6 months of pregnancy. Of moderate or severe mitral regurgitation; doubt determined to room thrombosis; valve with severe calcification or chordal fusion significantly reduced in patients with type dissection should be straight lines. 3. Indications for the artificial valve replacement: heart function in 3 to 4, accompanied by significant mitral regurgitation, and (or aortic valve disease and increased left ventricular; valve repair severe calcification that can not be separated; calcified atherosclerotic tumor causing stenosis. used mechanical valves or biological valves. mechanical valve durability, without calcification or infection, but to be life-long anticoagulation therapy; associated with ulcer disease or bleeding disorders were hanged. bioprosthetic valve without anticoagulant therapy, but may be due to infective endocarditis or valvular calcification after several years of injury or mechanical failure. 2 Common sense prevention of rheumatic valvular heart disease with mitral stenosis caused mainly due to repeated attacks of rheumatic fever, therefore, is to prevent recurrent rheumatic fever prevention the emergence and development of the disease key. early days of chronic rheumatic mitral stenosis without obvious symptoms, if any, due after the event flustered early hospital for treatment of asthma patients, in order to facilitate early detection and early treatment, such as mitral stenosis are clearly patients, medical treatment should be regularly and timely treatment. pure mitral stenosis and possible expansion of closed mitral valve surgery. mitral valve regurgitation in line valve replacement. For caused by the rheumatic mitral stenosis, and its preventive measures following main points: 1. rheumatic fever should be early diagnosis and treatment. 2. Control pharyngeal streptococcal infection, rheumatic activities of recurrence. 3. Prevention of infective endocarditis. pay attention to oral hygiene, insist on a regular basis show teeth, cleaning teeth and so on. the cold and exercise, and timely treatment of influenza and other streptococcal infections. 4. decompensated: proper rest, limiting sodium intake, diuretics, to improve the status of oral health care   attention to heart rate and rhythm changes.   pay attention to oral health, the timely processing of hidden lesions.   keep warm, try to avoid upper respiratory tract infection.   patients with longer periods of time in bed, cough with sputum, the need to help more than turning over, shot back, changing body position to facilitate sputum expectoration. and timely medical treatment given to prevent pneumonia.   on regular follow-up review. 3