The vast majority of mitral stenoses (mitral stenosis) are sequelae of rheumatic fever. Very few are congenital stenoses or age-related mitral annulus or subannular calcification. Two-thirds of patients with mitral stenosis are women. Approximately 40% of patients with rheumatic heart disease (rheumatic heart disease) have simple mitral stenosis. Symptoms Mitral stenosis Typically, symptoms of significant mitral stenosis can last up to 10 years from the time of initial rheumatic heart disease; thereafter, 10 to 20 years of gradual loss of activity. 1, dyspnea Labor force dyspnea is the earliest symptom, mainly due to reduced lung compliance. With the development of the disease, dyspnea can occur with daily activities, as well as sitting breathing, and acute pulmonary edema can be induced when there are triggers such as exertion, emotional excitement, respiratory tract infection, sexual intercourse, pregnancy or rapid atrial fibrillation. 2. Cough mostly at night during sleep and after labor. Mostly dry cough; coughing mucus-like or pus-like sputum when complicated by bronchitis or lung infection. If the left atrium is obviously enlarged and compresses the bronchus, it may also cause coughing. 3, hemoptysis ① blood in sputum or hematochezia, related to bronchitis, lung infection, and pulmonary congestion or capillary rupture; often accompanied by nocturnal paroxysmal dyspnea; in the late stage of mitral stenosis bleeding pulmonary infarction, also hematochezia; ② massive hemoptysis, due to the sudden increase of pressure in the left atrium, resulting in bronchial vein rupture bleeding. It is mostly seen in patients with early mitral stenosis and only mild or moderate pulmonary artery augmentation; ③ pink foamy sputum, which is caused by capillary rupture and is characteristic of acute pulmonary edema. (4) Chest pain is present in about 15% of patients with mitral stenosis and may be due to increased tension in the hypertrophied right ventricular wall and decreased cardiac output resulting in right ventricular ischemia. It can be relieved by mitral valve dissection or dilatation. 5. Thromboembolism occurs in 20% of patients with mitral stenosis during the course of the disease, of which 80% have atrial fibrillation. Embolism can occur in the cerebral vessels, coronary arteries, and renal arteries, and can recur in some patients. Or it may be a multi occurrence embolism. 6, other symptoms left atrial enlargement and left pulmonary artery dilatation can compress the left recurrent laryngeal nerve, causing hoarseness; significant enlargement of the left atrium can compress the esophagus, causing difficulty in swallowing; right ventricular failure can appear in the loss of appetite, abdominal distension, nausea and other symptoms. Features 1, heart auscultation apical region diastolic late low-pitched rumble-like murmur, incremental, limited, obvious in left lateral recumbency, may be accompanied by diastolic tremor. The first heart sound in the apical region is hyperactive and beat-like. In 80% to 85% of patients, the mitral valve opening sound (openingsnap, os) can be heard in the left sternal margin between 3 and 4 ribs or laterally in the apical region, which follows the second heart sound, is high-pitched, short and loud, and is obvious during exhalation. Stenosis and the fact that the valve is still somewhat pliable and mobile can contribute to the diagnosis of septal mitral stenosis and have some significance in deciding the method of surgical treatment. As a result of pulmonary hypertension, hyperacusis and splitting of the second heart sound of the pulmonary valve may be present. In severe pulmonary hypertension, a high-pitched, decreasing early to mid-diastolic murmur can be heard between the 2nd and 4th ribs at the left sternal border, blowing in a wind-like fashion, along the left sternal border toward the tricuspid region, and increasing during inspiration. This is due to the dilatation of the pulmonary artery and its annulus, resulting in a murmur of relative pulmonary valve insufficiency (graham-settll murmur). Sometimes an early systolic pulmonary valve murmur can also be heard, which is pronounced during expiration and diminished during inspiration. In patients with severe mitral stenosis, right ventricular enlargement due to pulmonary hypertension causes enlargement of the tricuspid annulus, resulting in relative tricuspid valve insufficiency. During right ventricular systole, part of the blood flow returns to the right atrium through the tricuspid orifice, resulting in a full systolic blowing murmur in the tricuspid region, which is conducted to the apical region and is obvious during inspiration. 2, other signs mitral valve face is seen in patients with severe mitral stenosis, due to reduced cardiac output, the patient has purplish-red cheek and mild cyanosis of the lips and mouth. Cyanosis is also seen at the end of the extremities. In patients with mitral stenosis in childhood, an elevation of the precordial region is seen, with a shift of the left papilla to the left upper atrium and a systolic lifting-like pulsation at the left sternal border. Significant jugular venous pulsation indicates the presence of severe pulmonary hypertension. Etiology and pathogenesis The normal mitral valve is soft and has an orifice area of about 4-6 cm2; when the orifice area decreases to 1.5-2.0 cm2, it is mild stenosis; when 1.0-1.5 cm2, it is moderate stenosis.