{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T18:10:05Z","timestamp":1784916605589,"version":"3.55.0"},"reference-count":74,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T00:00:00Z","timestamp":1744329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Rheumatic heart disease (RHD) and its complications are major health problems worldwide, especially in developing countries, owing to their high prevalence. Mitral stenosis (MS) is one of the most common lesions in RHD, either isolated or in combination with mitral regurgitation, and eventually leads to atrial fibrillation (AF), congestive heart failure, pulmonary hypertension (PH), and other complications, including ischemic stroke or limb ischemia, if not promptly diagnosed and treated. Recent studies have suggested that MS affects the cardiovascular system beyond mere obstructions. The presence of MS in RHD causes significant changes in the cardiovascular system, both upstream and downstream, affecting both the left and right ventricles. Rheumatic MS causes significant structural changes through inflammatory pathways and hemodynamic changes, owing to its obstructive effects. This review aims to discuss the vast changes in the cardiovascular system caused by rheumatic MS.<\/jats:p>","DOI":"10.3390\/jcm14082639","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T10:05:51Z","timestamp":1744365951000},"page":"2639","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Upstream and Downstream Cardiovascular Changes in Rheumatic Mitral Stenosis: An Update"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9230-1630","authenticated-orcid":false,"given":"Estu","family":"Rudiktyo","sequence":"first","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia\u2014National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5305-1619","authenticated-orcid":false,"given":"Arco J.","family":"Teske","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3584 Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emir","family":"Yonas","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia\u2014National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ade M.","family":"Ambari","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia\u2014National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J.","family":"Cramer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3584 Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1718-9949","authenticated-orcid":false,"given":"Marco","family":"Guglielmo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3584 Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5314-0442","authenticated-orcid":false,"given":"Tommaso","family":"Semino","sequence":"additional","affiliation":[{"name":"Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, 16126 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3998-1590","authenticated-orcid":false,"given":"Bambang Budi","family":"Siswanto","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia\u2014National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter A.","family":"Doevendans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3584 Utrecht, The Netherlands"},{"name":"Central Military Hospital, 3584 Utrecht, The Netherlands"},{"name":"Netherlands Heart Institute, 3511 Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amiliana M.","family":"Soesanto","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia\u2014National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s13075-022-02829-3","article-title":"Global burden of rheumatic heart disease: Trends from 1990 to 2019","volume":"24","author":"Ou","year":"2022","journal-title":"Arthritis Res. 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