Despite its declining frequency, rheumatic heart disease is still the most common cause of mitral valve stenosis. Scarring from rheumatic endocarditis causes fusion of the commissures and matting of the chordae tendineae, which interfere with valve closure. Calcification over time makes the valve less mobile. Progressive stenosis may lead to pulmonary hypertension, which may signal the need for surgery. The majority of patients eventually develop atrial fibrillation because of progressive dilation of the atria. Pulmonary hypertension may lead to pulmonary and tricuspid valve incompetence.
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