Oct 13, 2015
Valvular Heart Diseasedr Putra Hendra SpPDUNIBA
Cardiac Anatomy 101
Spectrum of VHD Aortic Valve Mitral Valve Tricuspid Valve Pulmonic Valve
Spectrum of VHD Regurg Aortic Valve Stenosis Regurg Mitral Valve Stenosis Regurg Tricuspid Valve Stenosis Regurg Pulmonic Valve Stenosis
Spectrum of VHD RegurgAcuteAortic ValveChronicStenosisAcuteChronicRegurgAcuteMitral ValveChronicStenosisAcuteChronicRegurgAcuteTricuspid ValveChronicStenosisAcuteChronicRegurgAcutePulmonic ValveChronicStenosisAcuteChronic
Mitral Valve Disease: EtiologyMitral StenosisRheumatic - 99.9%!!!CongenitalProsthetic valve stenosisMitral Annular CalcificationLeft Atrial Myxoma
Acute Mitral RegurgitationInfective endocarditisIschemic Heart diseasePapillary ms ruptureMitral valve prolapseChordal ruptureChest trauma
Chronic Mitral RegurgitationIschemic Heart diseasePapillary ms dysfunctionInferior & posterior MIMitral Valve prolapseInfective endocarditisRheumaticProstheticMitral annular calcificationCardiomyopathyLV dilatationIHSS
Valvular Heart DiseaseMitral Valve
Mitral RegurgitationMitral Stenosis
Mitral RegurgitationEtiologies
Alterations of the Leaflets, Commissures, AnnulusRheumaticMVPEndocarditis
Alterations of LV or LA size and FunctionPapillary Muscle (Ischemic, MI, Myocarditis, DCM)HOCMLV Enlargement Cardiomyopathies - LA Enlargement from MR MR begets MR
Mitral Regurg pathophysiology
Mitral Regurg pathophysiology
Mitral Regurg pathophysiology
Mitral RegurgitationSymptoms
Fatigue and weakness Dyspnea and orthopneaRight sided HFMVP Syndrome (if present)
Mitral RegurgitationPhysical Exam
Holosystolic Apical Blowing Murmur Laterally displaced apical impulseSplit S2 (but is obscured by the murmur)S3 Gallop (increased volume during diastole)Radiation depends on the etiology
Mitral Regurgitation- SBE Prophylaxis
Mitral Regurgitation
Mitral Regurgitation -MVP
Mitral Regurgitation -MVP
Mitral StenosisEtiologiesRheumatic almost all cases in adultsMitral Annular Ca+ - massive (rare)Congenital rare
60% of pts dont have a history of ARC50% of pts who have ARC dont develop VHD
Mitral Stenosis
Mitral Stenosis
Mitral Stenosis
Mitral StenosisPhysical ExamLoud S1Opening SnapDiastolic Apical Rumble (murmur)May be associated with:MR or ASRight Sided MurmursPI Graham Steel MurmurTR
Mitral StenosisTreatment of Symptomatic Mitral Stenosis
Medical Therapy treats the symptoms not the causeDiuretics for congestionDigoxin, Beta and Ca Channel Blockers for Afib rate controlAnticoagulation for AFib and LA clotsSBE Prophylaxix prevent endocarditis
Mitral StenosisTreatment of Symptomatic Mitral Stenosis
Surgical Therapy treats the causePercutaneous Ballon Valvulaoplasty Non-calcified, pliable valve
Balloon Mitral Commissurotomy
Mitral StenosisTreatment of Symptomatic Mitral Stenosis
Surgical Therapy treats the causeOpen Commisurotomy valve repairMitral Valve Replacement
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