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New Insights Into Mitral Valve Disease: Study Reveals Acquired Stenosis in Older Cats
Journal of Veterinary Cardiology 2025
Obi Veterinary Education
January 16, 2026
N. Schreiber, F. Prisco, A. Kipar, L. Schurna, M. Tursi, M.B. Toaldo
Background:
Valvular mitral stenosis (VMS) is rarely reported in cats, with most previous cases presumed congenital or post-inflammatory. This study aimed to characterize the clinical, echocardiographic, and pathological features of VMS in a larger cohort of adult cats, exploring whether some cases could represent an acquired condition.
Methods:
A retrospective observational study was conducted on 18 adult cats diagnosed with VMS via echocardiography between 2013 and 2023. Clinical records, laboratory data, imaging findings, treatments, and outcomes were reviewed. Four cats underwent postmortem examination, including gross pathology and histology with special staining and immunohistochemistry to characterize mitral valve lesions.
Results:
The median age was 13.2 years, with a majority being female and European shorthair cats. Fifteen cats had congestive heart failure (CHF) at presentation, and nine had concurrent hyperthyroidism. Echocardiography revealed a hockey-stick deformity of the anterior mitral leaflet with turbulent diastolic flow. Median survival after diagnosis was 366 days. Postmortem findings in four cats revealed diffuse fibrosis of the mitral valve leaflets and adjacent left ventricular endocardium, predominantly composed of type I collagen with minimal inflammatory cell infiltrate. In one case, prior normal echocardiography confirmed that VMS developed later in life, suggesting an acquired etiology.
Limitations:
The retrospective design and small sample size limit the generalizability of results. Only a subset of cases underwent postmortem confirmation, and longitudinal imaging data were mostly unavailable. Echocardiographic evaluations were not fully standardized across the entire cohort.
Conclusions:
Valvular mitral stenosis in cats can be acquired, arising through chronic fibrotic remodeling rather than being solely congenital. This study highlights the importance of considering VMS in older cats presenting with CHF, especially in the context of concurrent hyperthyroidism. Echocardiography remains key to diagnosis, and postmortem findings reveal a distinct fibrotic pathology that mirrors chronic remodeling rather than active inflammation.
Transthoracic echocardiographic images from two cats with valvular mitral stenosis. (A) Right parasternal long-axis four-chamber view from two different cats demonstrating the tethering and diastolic doming (‘hockey-stick’) appearance of the anterior leaflet of the mitral valve. (B) Left apical view showing a turbulent aliased diastolic flow on color Doppler across the mitral valve and within the left ventricular cavity (Nyquist limit: 73.2 cm/s). (C) Continuous wave Doppler spectral flow profile obtained from the left apical four-chamber view illustrating increased velocity of the early (E) and late (A) transmitral diastolic waves and a decreased E-F slope (dotted line).
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