Hemodynamic alterations and structural sequelae of mitral stenosis

This figure illustrates the progressive hemodynamic alterations and structural sequelae of mitral stenosis. Obstruction to flow through the stenotic valve leads to chronic LA pressure overload, which over time results in PVH and LA enlargement. Remodeling of the LA is the substrate of atrial fibrillation and in-situ thrombi. An enlarged LA may cause left recurrent laryngeal nerve compression. PVH promotes broncho-pulmonary venous anastomoses and passively increases pulmonary arterial pressures. In another group of patients with mitral stenosis, PAH bears little relationship to the LA pressure. This type of reactive PAH is due to vasoconstriction and pathological remodeling of the pulmonary vasculature (medial hypertrophy and intimal hyperplasia). The vascular remodeling and in-situ arteriolar thrombosis promote progressive PAH, RV pressure overload, RV dilation, and TR.