{"id":6413,"date":"2026-04-01T18:35:46","date_gmt":"2026-04-01T15:35:46","guid":{"rendered":"https:\/\/wiki.voka.io\/diseases\/uncategorized\/estenose-mitral\/"},"modified":"2026-04-16T13:54:50","modified_gmt":"2026-04-16T10:54:50","slug":"estenose-mitral","status":"publish","type":"diseases_post","link":"https:\/\/wiki.voka.io\/pt\/doencas\/cardiologia\/estenose-mitral\/","title":{"rendered":"Estenose mitral: etiologia, patog\u00eanese, sintomas, diagn\u00f3stico e m\u00e9todos de tratamento."},"content":{"rendered":"<p>Estenose mitral (EM) \u00e9 um estreitamento patol\u00f3gico do orif\u00edcio mitral, que leva \u00e0 dificuldade de enchimento diast\u00f3lico do ventr\u00edculo esquerdo, bem como ao aumento da press\u00e3o no \u00e1trio esquerdo e no leito pulmonar.<\/p>\n<p>Nos pa\u00edses desenvolvidos, a EM \u00e9 bem rara e est\u00e1 principalmente associada \u00e0 febre reum\u00e1tica pr\u00e9via, enquanto nas regi\u00f5es em desenvolvimento ela continua sendo uma causa significativa de defeitos valvares. As mulheres s\u00e3o mais propensas a desenvolver a doen\u00e7a do que os homens. Os sintomas geralmente se manifestam ap\u00f3s 10 a 30 anos.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/1-mitral-valve-normal.webp\" alt=\"V\u00e1lvula mitral normal. 1 - c\u00faspide posterior, 2 - c\u00faspide anterior, 3 - m\u00fasculo papilar anterolateral, 4 - m\u00fasculo papilar posteromedial\"><figcaption class=\"wp-element-caption\">V\u00e1lvula mitral normal. 1 \u2013 c\u00faspide posterior, 2 \u2013 c\u00faspide anterior, 3 \u2013 m\u00fasculo papilar anterolateral, 4 \u2013 m\u00fasculo papilar posteromedial \u2013 <a href=\"https:\/\/catalog.voka.io\/ru\/models\/d1df170c-51ef-4d23-93b5-0380d03866e5\/befbeb9a-0f4f-437b-ae62-98b234d86334\/8ccb3047-bff0-4e2e-8402-2a4c56b66488\/e72e5fce-4895-4c18-9978-b12998dcd92c\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Modelo 3D<\/a><\/figcaption><\/figure>\n<h2 class=\"wp-block-heading\" id=\"etiologia-da-em\">Etiologia da EM<\/h2>\n<ul class=\"wp-block-list\">\n<li><strong>Doen\u00e7a card\u00edaca reum\u00e1tica<\/strong> \u00e9 a principal causa de estenose mitral (cerca de 90% dos casos). Em pa\u00edses com medicina avan\u00e7ada, observa-se uma diminui\u00e7\u00e3o na incid\u00eancia da estenose reum\u00e1tica.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/2-rheumatic-mitral-stenosis.webp\" alt=\"Estenose mitral reum\u00e1tica\"><figcaption class=\"wp-element-caption\">Estenose mitral reum\u00e1tica \u2013 <a href=\"https:\/\/catalog.voka.io\/ru\/models\/d1df170c-51ef-4d23-93b5-0380d03866e5\/4c087bf8-9aea-42db-8481-bcf40a34fc93\/93904017-aecc-44b2-9535-94be1533a1cc\/b9dbb18a-0fd7-4cc9-8765-4c9c00739a16\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Modelo 3D<\/a><\/figcaption><\/figure>\n<ul class=\"wp-block-list\">\n<li><strong>Estenose degenerativa<\/strong> \u2014 \u00e9 associada \u00e0 calcifica\u00e7\u00e3o do anel mitral. Esta \u00e9 a segunda causa mais comum. A estenose degenerativa \u00e9 muito comum em pacientes idosos.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Doen\u00e7a valvar card\u00edaca induzida por radia\u00e7\u00e3o<\/strong> \u2013 desenvolve-se 10 a 20 anos ap\u00f3s a irradia\u00e7\u00e3o mediastinal; ela \u00e9 causada pela fibrose e pelo espessamento das estruturas valvares.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Formas cong\u00eanitas<\/strong> da estenose mitral s\u00e3o raras e geralmente aparecem na inf\u00e2ncia. <\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Doen\u00e7as infiltrativas e sist\u00eamicas <\/strong>(doen\u00e7a de Fabry, mucopolissacaridoses, doen\u00e7a card\u00edaca carcinoide, fibrose endomioc\u00e1rdica, l\u00fapus, etc.) s\u00e3o causas extremamente raras.<\/li>\n<\/ul>\n<p>A verdadeira estenose deve ser diferenciada da obstru\u00e7\u00e3o do fluxo mitral de origem n\u00e3o valvar, que ocorre em casos de mixoma do \u00e1trio esquerdo, trombose, grandes vegeta\u00e7\u00f5es infecciosas e degenera\u00e7\u00e3o de biopr\u00f3tese mitral.<\/p>\n<h2 class=\"wp-block-heading\" id=\"patogenese\">Patog\u00eanese<\/h2>\n<h3 class=\"wp-block-heading\" id=\"alteracoes-valvares-e-anatomicas\">Altera\u00e7\u00f5es valvares e anat\u00f4micas.<\/h3>\n<ul class=\"wp-block-list\">\n<li><strong>Na doen\u00e7a card\u00edaca reum\u00e1tica<\/strong>, a inflama\u00e7\u00e3o cr\u00f4nica mediada pelo sistema imunol\u00f3gico leva \u00e0 fibrose das c\u00faspides, \u00e0 fus\u00e3o das comissuras e espessamento e ao encurtamento das cordas tend\u00edneas. Isso resulta em um estreitamento central do orif\u00edcio mitral com uma protuber\u00e2ncia em das c\u00faspides mitrais forma de c\u00fapula. Com o tempo, o fluxo turbulento aumenta a calcifica\u00e7\u00e3o e a rigidez valvar, agravando a estenose.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Na calcifica\u00e7\u00e3o degenerativa do anel mitral<\/strong>, a fibrocalcifica\u00e7\u00e3o se estende do anel at\u00e9 a base das c\u00faspides, limitando sua mobilidade sem fus\u00e3o t\u00edpica das comissuras.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/3-degenerative-mitral-valve-stenosis.webp\" alt=\"Estenose mitral degenerativa\n\"><figcaption class=\"wp-element-caption\">Estenose mitral degenerativa \u2013 <a href=\"https:\/\/catalog.voka.io\/ru\/models\/d1df170c-51ef-4d23-93b5-0380d03866e5\/4c087bf8-9aea-42db-8481-bcf40a34fc93\/93904017-aecc-44b2-9535-94be1533a1cc\/73a868aa-da7b-42ba-91ee-5f3d71501087\">Modelo 3D<\/a><\/figcaption><\/figure>\n<h3 class=\"wp-block-heading\" id=\"disturbios-hemodinamicos\">Dist\u00farbios hemodin\u00e2micos<\/h3>\n<ol class=\"wp-block-list\">\n<li>O estreitamento do orif\u00edcio mitral causa um aumento no gradiente diast\u00f3lico entre o \u00e1trio esquerdo e o ventr\u00edculo esquerdo.<\/li>\n<li>A sobrecarga cr\u00f4nica leva ao aumento da press\u00e3o no \u00e1trio esquerdo <strong>. <\/strong>\u00c0 medida que a \u00e1rea valvar diminui, o enchimento do ventr\u00edculo esquerdo fica limitado e o d\u00e9bito card\u00edaco diminui.<\/li>\n<li>A sobrecarga de press\u00e3o prolongada causa a dilata\u00e7\u00e3o, a hipertrofia e a fibrose do \u00e1trio esquerdo, contribuindo para o desenvolvimento de fibrila\u00e7\u00e3o atrial e cria condi\u00e7\u00f5es para a forma\u00e7\u00e3o de trombos intra-atriais.<\/li>\n<li>O aumento da press\u00e3o no \u00e1trio esquerdo \u00e9 transmitido \u00e0s veias e aos capilares pulmonares, causando a hipertens\u00e3o pulmonar p\u00f3s-capilar e a remodela\u00e7\u00e3o vascular pulmonar.<\/li>\n<li>A progress\u00e3o leva \u00e0 sobrecarga do ventr\u00edculo direito, \u00e0 insufici\u00eancia do ventr\u00edculo direito e \u00e0 regurgita\u00e7\u00e3o tric\u00faspide funcional.<\/li>\n<\/ol>\n<h2 class=\"wp-block-heading\" id=\"manifestacoes-clinicas\">Manifesta\u00e7\u00f5es cl\u00ednicas<\/h2>\n<ul class=\"wp-block-list\">\n<li><strong>Fase assintom\u00e1tica prolongada<\/strong>;<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Falta de ar<\/strong> ao fazer esfor\u00e7o e, posteriormente, at\u00e9 em repouso. Com a progress\u00e3o da doen\u00e7a, podem ocorrer a ortopneia e o engasgamento noturno.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Diminui\u00e7\u00e3o da toler\u00e2ncia ao exerc\u00edcio e fadiga<\/strong> est\u00e3o associadas \u00e0 limita\u00e7\u00e3o do d\u00e9bito card\u00edaco e \u00e0 redu\u00e7\u00e3o do enchimento diast\u00f3lico do ventr\u00edculo esquerdo;<\/li>\n<li><strong>Fibrila\u00e7\u00e3o atrial<\/strong> pode ser o primeiro sinal cl\u00ednico da doen\u00e7a. Na maioria das vezes, ela piora a hemodin\u00e2mica de forma abrupta devido \u00e0 taquicardia e \u00e0 perda da contribui\u00e7\u00e3o atrial para o enchimento ventricular;<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/atrial-fibrillation-ecg-example.webp\" alt=\"Um exemplo de fibrila\u00e7\u00e3o atrial no ECG.\"><figcaption class=\"wp-element-caption\">Um exemplo de fibrila\u00e7\u00e3o atrial no ECG.<\/figcaption><\/figure>\n<ul class=\"wp-block-list\">\n<li><strong>Hemoptise <\/strong>\u2014 ocorre como resultado da hipertens\u00e3o pulmonar e da ruptura das veias br\u00f4nquicas;<\/li>\n<li><strong>Embolia sist\u00eamica<\/strong> \u2014 ocorre devido ao alto risco de forma\u00e7\u00e3o de trombos no \u00e1trio esquerdo;<\/li>\n<li><strong>Sinais de insufici\u00eancia ventricular direita<\/strong> \u2014 edema dos membros inferiores, ascite, etc.<\/li>\n<li><strong>Rouquid\u00e3o<\/strong> (s\u00edndrome de Ortner) \u2014 ocorre devido \u00e0 compress\u00e3o do nervo recorrente pelo \u00e1trio esquerdo aumentado.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\" id=\"diagnostico-da-estenose-mitral\">Diagn\u00f3stico da estenose mitral<\/h2>\n<p>N\u00e3o existem marcadores laboratoriais espec\u00edficos. O BNP \/ NT-proBNP \u00e9 utilizado para avaliar a gravidade da insufici\u00eancia card\u00edaca.<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Ecocardiografia transtor\u00e1cica (ETT)<\/strong> \u00e9 um m\u00e9todo diagn\u00f3stico fundamental para a estenose mitral.\n<ul class=\"wp-block-list\">\n<li><strong>Avalia\u00e7\u00e3o morfol\u00f3gica:<\/strong> espessamento e fus\u00e3o parcial das c\u00faspides; encurtamento e fibrose do aparelho cordal; mobilidade limitada das c\u00faspides, abaulamento em forma de c\u00fapula da c\u00faspide anterior durante a di\u00e1stole; tamanho do \u00e1trio esquerdo, presen\u00e7a de trombos intra-atriais; condi\u00e7\u00e3o do lado direito do cora\u00e7\u00e3o.<\/li>\n<li><strong>Classifica\u00e7\u00e3o pela \u00e1rea do orif\u00edcio efetivo<\/strong> (\u2264 1,0 cm<sup>2<\/sup> \u2014 estenose grave com alto risco, \u2264 1,5 cm<sup>2<\/sup> \u2014 estenose grave, > 1,5 cm<sup>2<\/sup> \u2014 estenose n\u00e3o hemodinamicamente significativa). <\/li>\n<li><strong>Gradiente transmitral m\u00e9dio<\/strong>: em estenose grave maior que 10 mmHg. p.<\/li>\n<li><strong>T\u00e9cnica Doppler<\/strong> \u2014 permite medir a velocidade do fluxo transmitral; calcular os gradientes de pico e m\u00e9dio; avaliar a press\u00e3o sist\u00f3lica na art\u00e9ria pulmonar utilizando o jato de regurgita\u00e7\u00e3o tric\u00faspide; e identificar a regurgita\u00e7\u00e3o mitral concomitante.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Ecocardiografia com estresse<\/strong> (com exerc\u00edcio ou dobutamina) \u2014 \u00e9 realizada se houver discrep\u00e2ncia entre a gravidade dos sintomas e os dados da ETT em repouso. Esse exame permite avaliar o aumento do gradiente transmitral e a hipertens\u00e3o pulmonar.<\/li>\n<li><strong> Ecocardiograma transesof\u00e1gico (ETE)<\/strong>\n<ul class=\"wp-block-list\">\n<li>Permite avalizar a morfologia das c\u00faspides e das comissuras.<\/li>\n<li>\u00c9 realizado antes da comissurotomia mitral por cateter bal\u00e3o para excluir a presen\u00e7a de trombos no \u00e1trio esquerdo e no ap\u00eandice atrial, bem como para esclarecer o grau de regurgita\u00e7\u00e3o mitral ap\u00f3s o procedimento.<\/li>\n<li>O contraste ecocardiogr\u00e1fico espont\u00e2neo no \u00e1trio esquerdo \u00e9 um marcador de congest\u00e3o grave e de alto risco tromboemb\u00f3lico, frequentemente associado a uma pequena \u00e1rea do orif\u00edcio mitral e um gradiente alto.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Angiotomografia<\/strong> \u00e9 um procedimento \u00fatil quando \u00e9 necess\u00e1rio avaliar a anatomia do t\u00f3rax, a condi\u00e7\u00e3o da aorta e dos vasos dos membros inferiores, bem como decidir sobre o tipo de abordagem cir\u00fargica no planejamento da cirurgia da v\u00e1lvula mitral.<\/li>\n<li><strong>Cateterismo invasivo<\/strong> \u00e9 raramente utilizado, sendo indicado quando os dados n\u00e3o invasivos s\u00e3o inconsistentes.<\/li>\n<\/ul>\n<div class=\"social-banner-block\">\n<div class=\"social-banner-content\">\n<p class=\"h5-title text-black\">Encontra mais conte\u00fados cientificamente exactos nas nossas redes sociais<\/p>\n<p><span class=\"social-banner-text text-grey\">Subscreve e n\u00e3o percas os recursos mais recentes<\/span><\/p>\n<div class=\"social-links-wrapper\"><a class=\"social-icon-link\" href=\"https:\/\/www.facebook.com\/VOKA3DAnatomyAndPathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/facebook.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.instagram.com\/voka.io\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/insta.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.linkedin.com\/company\/voka-io\/posts\/?feedView=all\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/linkedin.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.youtube.com\/@vokaio\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/youtube.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.pinterest.com\/voka3danatomyandpathology\/\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/pinterest.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/www.tiktok.com\/@voka.io\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/tiktok.svg\" alt=\"social link\"><\/a><a class=\"social-icon-link\" href=\"https:\/\/discord.gg\/7ejUpq8DRR\" target=\"_blank\" rel=\"nofollow noopener\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/Social%20Icons\/discord.svg\" alt=\"social link\"><\/a><\/div>\n<\/div>\n<p><img decoding=\"async\" class=\"social-banner-image\" loading=\"lazy\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/common\/social-media-banner-mobile-image.webp\" alt=\"Banner background\"><\/div>\n<h2 class=\"wp-block-heading\" id=\"tratamento\">Tratamento<\/h2>\n<h3 class=\"wp-block-heading\" id=\"terapia-medicamentosa\">Terapia medicamentosa<\/h3>\n<p>A terapia medicamentosa n\u00e3o resolve a obstru\u00e7\u00e3o, mas \u00e9 utilizada para controlar os sintomas, estabilizar a hemodin\u00e2mica, monitorar as complica\u00e7\u00f5es e preparar o paciente para a cirurgia.<\/p>\n<ul class=\"wp-block-list\">\n<li><strong>Diur\u00e9ticos <\/strong>\n<ul class=\"wp-block-list\">\n<li>Diur\u00e9ticos de al\u00e7a (furosemida) reduzem a congest\u00e3o pulmonar e os sintomas de dispneia;<\/li>\n<li>S\u00e3o eficazes no tratamento da hipertens\u00e3o pulmonar e da insufici\u00eancia ventricular direita;<\/li>\n<li>A diurese aumentada pode reduzir o d\u00e9bito card\u00edaco e aumentar a fadiga.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Monitoriza\u00e7\u00e3o da frequ\u00eancia card\u00edaca<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Betabloqueadores<\/strong> s\u00e3o considerados f\u00e1rmacos de primeira linha. Eles prolongam a di\u00e1stole e reduzem o gradiente transmitral;<\/li>\n<li><strong>Bloqueadores dos canais de c\u00e1lcio n\u00e3o di-hidropirid\u00ednicos<\/strong> (verapamil, diltiazem) s\u00e3o uma alternativa caso os betabloqueadores sejam contraindicados;<\/li>\n<li><strong>Ivabradina<\/strong> pode ser usada em ritmo sinusal se houver intoler\u00e2ncia a betabloqueadores. Reduz a frequ\u00eancia card\u00edaca sem efeito inotr\u00f3pico negativo.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Digoxina<\/strong> pode ser usada em pacientes com FA, frequ\u00eancia card\u00edaca descontrolada ou disfun\u00e7\u00e3o sist\u00f3lica concomitante.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Fibrila\u00e7\u00e3o atrial<\/strong>\n<ul class=\"wp-block-list\">\n<li>A perda da contribui\u00e7\u00e3o atrial e a taquicardia na estenose mitral levam rapidamente ao edema pulmonar;<\/li>\n<li>Em caso de instabilidade hemodin\u00e2mica, \u00e9 necess\u00e1rio realizar a cardiovers\u00e3o el\u00e9trica.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Terapia anticoagulante<\/strong>\n<ul class=\"wp-block-list\">\n<li>\u00c9 indicada em pacientes com estenose mitral e FA, bem como em indiv\u00edduos com trombo no \u00e1trio esquerdo e\/ou no ap\u00eandice atrial, ou com hist\u00f3rico de embolia, independentemente do ritmo;<\/li>\n<li>Devido \u00e0 falta de evid\u00eancias suficientes sobre anticoagulantes orais, um antagonista da vitamina K (varfarina) com INR alvo entre 2,0 e 3,0 permanece o medicamento de escolha.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"tratamento-endovascular-valvuloplastia-percutanea-mitral-por-cateter-balao\">Tratamento endovascular (valvuloplastia percut\u00e2nea mitral por cateter bal\u00e3o) <\/h3>\n<p>Valvuloplastia percut\u00e2nea mitral por cateter bal\u00e3o \u00e9 o tratamento de escolha para pacientes com estenose reum\u00e1tica mitral e anatomia valvar favor\u00e1vel.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/percutaneous-balloon-mitral-valvuloplasty-image.webp\" alt=\"Representa\u00e7\u00e3o esquem\u00e1tica da valvuloplastia percut\u00e2nea mitral por cat\u00e9ter bal\u00e3o\"><figcaption class=\"wp-element-caption\">Representa\u00e7\u00e3o esquem\u00e1tica da valvuloplastia percut\u00e2nea mitral por cat\u00e9ter bal\u00e3o<\/figcaption><\/figure>\n<ul class=\"wp-block-list\">\n<li><strong>Indica\u00e7\u00f5es<\/strong>\n<ul class=\"wp-block-list\">\n<li>Estenose mitral grave sintom\u00e1tica (na maioria das vezes, de etiologia reum\u00e1tica);<\/li>\n<li>Estenose grave assintom\u00e1tica na presen\u00e7a da hipertens\u00e3o pulmonar (> 50 mmHg) e da fibrila\u00e7\u00e3o atrial;<\/li>\n<li>Sem indica\u00e7\u00e3o para a cirurgia aberta;<\/li>\n<li>Condi\u00e7\u00f5es anat\u00f4micas favor\u00e1veis: c\u00faspides m\u00f3veis, calcifica\u00e7\u00e3o m\u00ednima, les\u00f5es subvalvares limitadas, perfil morfol\u00f3gico favor\u00e1vel.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Contraindica\u00e7\u00f5es<\/strong>\n<ul class=\"wp-block-list\">\n<li>Trombo no \u00e1trio esquerdo ou no ap\u00eandice atrial;<\/li>\n<li>Insufici\u00eancia mitral moderada e grave;<\/li>\n<li>Calcifica\u00e7\u00e3o grave;<\/li>\n<li>Valvuloplastia percut\u00e2nea mitral por cateter bal\u00e3o pr\u00e9via mal sucedida.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>T\u00e9cnica<\/strong>\n<ul class=\"wp-block-list\">\n<li>O cateter bal\u00e3o \u00e9 passado atrav\u00e9s do septo interatrial para o \u00e1trio esquerdo e inflado ao n\u00edvel do orif\u00edcio mitral, rompendo as comissuras fundidas.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3 class=\"wp-block-heading\" id=\"tratamento-cirurgico\">Tratamento cir\u00fargico<\/h3>\n<ul class=\"wp-block-list\">\n<li><strong>Comissurotomia cir\u00fargica e reparo com preserva\u00e7\u00e3o da v\u00e1lvula<\/strong>\n<ul class=\"wp-block-list\">\n<li>\u00c9 indicada para pacientes com anatomia desfavor\u00e1vel para valvuloplastia percut\u00e2nea mitral por cateter bal\u00e3o, presen\u00e7a de trombo no \u00e1trio esquerdo ou les\u00f5es valvares associadas;<\/li>\n<li>O procedimento envolve a dissec\u00e7\u00e3o da comissura, a corre\u00e7\u00e3o das estruturas subvalvares e, se necess\u00e1rio, a anuloplastia.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Troca da v\u00e1lvula mitral<\/strong>\n<ul class=\"wp-block-list\">\n<li>\u00c9 indicada para casos de deforma\u00e7\u00e3o valvular grave, calcifica\u00e7\u00e3o grave, les\u00f5es valvares combinadas e estenose recorrente ap\u00f3s interven\u00e7\u00f5es repetidas;<\/li>\n<li>Al\u00e9m da esternotomia mediana, em casos de anatomia e condi\u00e7\u00f5es vasculares adequadas dos membros inferiores, a interven\u00e7\u00e3o na v\u00e1lvula mitral pode ser realizada por meio de uma minitoracotomia direita com circula\u00e7\u00e3o extracorp\u00f3rea realizada por veias femorais.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Pr\u00f3teses mec\u00e2nicas<\/strong> s\u00e3o recomendadas para pacientes jovens e de meia-idade (at\u00e9 60 anos) com expectativa de sobrevida prolongada. Elas requerem administra\u00e7\u00e3o cont\u00ednua de antagonistas da vitamina K. S\u00e3o menos indicadas para mulheres que querem engravidar.<\/li>\n<\/ul>\n<ul class=\"wp-block-list\">\n<li><strong>Pr\u00f3teses biol\u00f3gicas<\/strong> s\u00e3o recomendadas para pacientes idosos (65 anos ou mais) e mulheres em idade reprodutiva. Elas t\u00eam vida \u00fatil limitada devido \u00e0 degenera\u00e7\u00e3o estrutural e \u00e0 potencial necessidade de nova interven\u00e7\u00e3o.<\/li>\n<\/ul>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/storage.googleapis.com\/dev_wiki_voka_io_303011\/articles\/en\/cardiology\/mitral-valve-stenosis\/mechanical-and-biological-valves-left-right.webp\" alt=\"V\u00e1lvulas mec\u00e2nicas (esquerda) e biol\u00f3gicas (direita)\"><figcaption class=\"wp-element-caption\">V\u00e1lvulas mec\u00e2nicas (esquerda) e biol\u00f3gicas (direita)<\/figcaption><\/figure>\n<div>\n<h2 class=\"faq-title h2-article\" id=\"faq\">FAQ<\/h2>\n<div class=\"faq-section\">\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">1. Qual \u00e9 a principal causa da estenose mitral?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Na maioria dos casos, a estenose mitral \u00e9 causada pela doen\u00e7a card\u00edaca reum\u00e1tica, que leva ao estreitamento progressivo do orif\u00edcio mitral. <\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">2. Quando a estenose mitral \u00e9 considerada grave?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Quando a \u00e1rea valval \u00e9 abaixo de 1,5 cm\u00b2, especialmente em combina\u00e7\u00e3o com sintomas cl\u00ednicos ou sinais de hipertens\u00e3o pulmonar.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">3. Por que os sintomas da estenose mitral se tornam mais graves com a taquicardia?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">O aumento da frequ\u00eancia card\u00edaca reduz a di\u00e1stole, aumenta o gradiente transmitral e eleva a press\u00e3o no \u00e1trio esquerdo e nas veias pulmonares.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">4. Qual \u00e9 o principal m\u00e9todo diagn\u00f3stico para a estenose mitral?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">O ecocardiograma transtor\u00e1cico \u00e9 o principal m\u00e9todo de avaliza\u00e7\u00e3o da \u00e1rea valvar, dos gradientes de press\u00e3o e do grau de hipertens\u00e3o pulmonar.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">5. Em que casos \u00e9 necess\u00e1rio realizar o<br \/>\necocardiograma transesof\u00e1gico (ETE)?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">O ETE \u00e9 indicado para excluir a presen\u00e7a de trombos no \u00e1trio esquerdo e para esclarecer a anatomia da v\u00e1lvula antes da comissurotomia por cateter bal\u00e3o ou da cirurgia.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">6. Como a estenose mitral grave sintom\u00e1tica \u00e9 tratada?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">O tratamento de escolha \u00e9 a comissurotomia percut\u00e2nea mitral por cateter bal\u00e3o quando a anatomia valvar \u00e9 favor\u00e1vel. Se houver contraindica\u00e7\u00f5es, \u00e9 recomendado optar pelo tratamento cir\u00fargico.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">7. Quando a corre\u00e7\u00e3o cir\u00fargica \u00e9 prefer\u00edvel para a estenose mitral?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">A cirurgia \u00e9 indicada quando a anatomia da v\u00e1lvula \u00e9 desfavor\u00e1vel, na presen\u00e7a da regurgita\u00e7\u00e3o mitral significativa ou do trombo no \u00e1trio esquerdo.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">8. Como pacientes com estenose mitral e fibrila\u00e7\u00e3o atrial s\u00e3o tratados?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">A base do tratamento \u00e9 o controle da frequ\u00eancia ventricular e a anticoagula\u00e7\u00e3o obrigat\u00f3ria com antagonistas da vitamina K na estenose reum\u00e1tica mitral.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">9. Por que os anticoagulantes orais diretos n\u00e3o s\u00e3o recomendados no tratamento da estenose reum\u00e1tica mitral?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">N\u00e3o existem evid\u00eancias suficientes para comprovar a maior efic\u00e1cia dos anticoagulantes orais diretos em rela\u00e7\u00e3o aos antagonistas da vitamina K no tratamento da estenose mitral reum\u00e1tica.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<div class=\"faq-item faq-answer-hidden\">\n<div class=\"question-block\">\n<div class=\"faq-question\">\n<p class=\" text-black h5-title\">10. Qual \u00e9 o tipo de pr\u00f3tese valvar mais indicado para a troca da v\u00e1lvula mitral?<\/p>\n<\/div>\n<div class=\"faq-answer text-main-text-color main-text-medium\">Pacientes com mais de 65 anos s\u00e3o recomendados optar pelas biopr\u00f3teses. Para pacientes mais jovens, s\u00e3o prefer\u00edveis as pr\u00f3teses mec\u00e2nicas, devido \u00e0 necessidade de anticoagula\u00e7\u00e3o vital\u00edcia.<\/div>\n<\/div>\n<div class=\"expand-button-wrapper\"><button class=\"text-accent expand-button\">+<\/button><\/div>\n<\/div>\n<\/div>\n<p><script type=\"application\/ld+json\">\n    {\n    \"@context\": \"https:\/\/schema.org\",\n    \"@type\": \"FAQPage\",\n    \"mainEntity\": [\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Qual \u00e9 a principal causa da estenose mitral?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"Na maioria dos casos, a estenose mitral \u00e9 causada pela doen\u00e7a card\u00edaca reum\u00e1tica, que leva ao estreitamento progressivo do orif\u00edcio mitral. \"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Quando a estenose mitral \u00e9 considerada grave?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"Quando a \u00e1rea valval \u00e9 abaixo de 1,5 cm\u00b2, especialmente em combina\u00e7\u00e3o com sintomas cl\u00ednicos ou sinais de hipertens\u00e3o pulmonar.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Por que os sintomas da estenose mitral se tornam mais graves com a taquicardia?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"O aumento da frequ\u00eancia card\u00edaca reduz a di\u00e1stole, aumenta o gradiente transmitral e eleva a press\u00e3o no \u00e1trio esquerdo e nas veias pulmonares.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Qual \u00e9 o principal m\u00e9todo diagn\u00f3stico para a estenose mitral?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"O ecocardiograma transtor\u00e1cico \u00e9 o principal m\u00e9todo de avaliza\u00e7\u00e3o da \u00e1rea valvar, dos gradientes de press\u00e3o e do grau de hipertens\u00e3o pulmonar.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Em que casos \u00e9 necess\u00e1rio realizar o \\necocardiograma transesof\u00e1gico (ETE)?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"O ETE \u00e9 indicado para excluir a presen\u00e7a de trombos no \u00e1trio esquerdo e para esclarecer a anatomia da v\u00e1lvula antes da comissurotomia por cateter bal\u00e3o ou da cirurgia.\"\n            }\n        },\n        {\n            \"@type\": \"Question\",\n            \"name\": \"Como a estenose mitral grave sintom\u00e1tica \u00e9 tratada?\",\n            \"acceptedAnswer\": {\n                \"@type\": \"Answer\",\n                \"text\": \"O tratamento de escolha \u00e9 a comissurotomia percut\u00e2nea mitral por cateter bal\u00e3o quando a anatomia valvar \u00e9 favor\u00e1vel. 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Para pacientes mais jovens, s\u00e3o prefer\u00edveis as pr\u00f3teses mec\u00e2nicas, devido \u00e0 necessidade de anticoagula\u00e7\u00e3o vital\u00edcia.\"\n            }\n        }\n    ]\n}<\/script><\/div>\n<div class=\"sources-list-block sources-list-hidden\" id=\"referencias\">\n<div class=\"sources-list-content\">\n<div class=\"sources-list-title\">\n<p class=\"small-text-bold text-black sources-list-title-text\">Refer\u00eancias<\/p>\n<div class=\"sources-expand-button-wrapper-mobile\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n<div class=\"sources-list-items\">\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">1.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>VOKA 3D Anatomy & Pathology \u2013 Complete Anatomy and Pathology 3D Atlas (VOKA 3D Anatomia e Patologia \u2013 Atlas 3D completo de anatomia e patologia) [Internet]. VOKA 3D Anatomy & Pathology [VOKA 3D Anatomia & Patologia].<\/cite><\/p>\n<p><span class=\"small-text-medium text-grey\">Dispon\u00edvel em: https:\/\/catalog.voka.io\/<\/span><\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">2.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Praz F, et al. 2025 ESC\/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2025 Nov 21;46(44):4635\u20134736. doi:10.1093\/eurheartj\/ehaf194.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">3.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Otto CM, et al. 2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb;77(4):e25\u2013e197. doi:10.1016\/j.jacc.2020.11.018.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">4.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Harb SC, Griffin BP. Mitral valve disease: a comprehensive review. Curr Cardiol Rep. 2017 Ago;19(8):73. doi:10.1007\/s11886-017-0883-5.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">5.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Kumar K, Simpson T. Transcatheter therapy for mitral valve stenosis. Interv Cardiol Clin. 2024 Apr;13(2):271\u2013278. doi:10.1016\/j.iccl.2024.01.003.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">6.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Wunderlich NC, et al. Rheumatic mitral valve stenosis: diagnosis and treatment options. Curr Cardiol Rep. 28 fev 2019; 21(3): 14. doi:10.1007\/s11886-019-1099-7.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">7.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Al-Taweel A, et al. Degenerative mitral valve stenosis: diagnosis and management. Echocardiography. 2019 Oct;36(10):1901\u20131909. doi:10.1111\/echo.14495.<\/cite><\/p>\n<\/div>\n<\/div>\n<div class=\"source-item\">\n<p class=\"main-text-semibold text-black\">8.<\/p>\n<div class=\"source-item-content\">\n<p class=\"main-text-semibold text-black\"><cite>Robinson S, et al. The assessment of mitral valve disease: a guideline from the British Society of Echocardiography. Echo Res Pract. 2021 Sep 27;8(1):G87\u2013G136. doi:10.1530\/ERP-20-0034.<\/cite><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sources-expand-button-wrapper\">\n<div class=\"sources-expand-button\"><svg width=\"32\" height=\"32\" viewbox=\"0 0 32 32\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M8 12L16 20L24 12\" stroke=\"#8C9AAB\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Estenose mitral (EM) \u00e9 um estreitamento patol\u00f3gico do orif\u00edcio mitral, que leva \u00e0 dificuldade de enchimento diast\u00f3lico do ventr\u00edculo esquerdo, bem como ao aumento da press\u00e3o no \u00e1trio esquerdo e no leito pulmonar. Nos pa\u00edses desenvolvidos, a EM \u00e9 bem rara e est\u00e1 principalmente associada \u00e0 febre reum\u00e1tica pr\u00e9via, enquanto nas regi\u00f5es em desenvolvimento ela [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"template":"","diseases_category":[293],"class_list":["post-6413","diseases_post","type-diseases_post","status-publish","hentry","diseases_category-cardiologia"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.0 (Yoast SEO v26.5) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Estenose mitral: sintomas, diagn\u00f3stico e tratamento<\/title>\n<meta name=\"description\" content=\"Estenose mitral \u00e9 um estreitamento patol\u00f3gico do orif\u00edcio mitral. 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