Valvular Heart Valvular Heart Disease Disease • Read Robbins 588-594 Read Robbins 588-594 • Web atlas: Valvular Heart Web atlas: Valvular Heart Disease Disease • Heart Sound Program (on all Heart Sound Program (on all student computers-- same student computers-- same authors on web site: authors on web site: www.blaufuss.org/tutorial/ind extut.html
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Valvular Heart Valvular Heart DiseaseDisease
•Read Robbins 588-594Read Robbins 588-594
•Web atlas: Valvular Heart Web atlas: Valvular Heart DiseaseDisease
•Heart Sound Program (on all Heart Sound Program (on all student computers-- same student computers-- same authors on web site: authors on web site: www.blaufuss.org/tutorial/indextut.html
Valvular Heart Valvular Heart DiseaseDisease
•Stenosis - failure of a valve Stenosis - failure of a valve to open completely - impeding to open completely - impeding forward flowforward flow
•Insufficiency - failure of a Insufficiency - failure of a valve to close completely - valve to close completely - allowing reversed flow(also allowing reversed flow(also called regurgitation)called regurgitation)
Abnormalities of the Abnormalities of the Mitral ValveMitral Valve
•Valve LeafletsValve Leaflets
•Chordae TendineaeChordae Tendineae
•Papillary MusclesPapillary Muscles
•Mitral AnnulusMitral Annulus
Abnormalities of the Abnormalities of the Valve LeafletsValve Leaflets
•Rheumatic Heart DiseaseRheumatic Heart Disease
•shortening, rigidity, shortening, rigidity, deformity and retraction of deformity and retraction of the leafletsthe leaflets
•Infective EndocarditisInfective Endocarditis
•Perforation and Perforation and retraction(healing)retraction(healing)
Abnormalities of the Abnormalities of the Mitral AnnulusMitral Annulus
•DilationDilation
•normally the normally the mitral annulus mitral annulus constricts during constricts during systole. A systole. A dilated left dilated left ventricle will ventricle will result in dilation result in dilation of the mitral of the mitral annulus and result annulus and result in mitral in mitral regurgitation.regurgitation.
Abnormalities of the Abnormalities of the Mitral AnnulusMitral Annulus
•Calcification of annulusCalcification of annulus
•one of the most common cardiac one of the most common cardiac abnormalities found at autopsy. abnormalities found at autopsy.
•Usually of little consequence Usually of little consequence but may immobilize the basal but may immobilize the basal portions of the MV leaflets portions of the MV leaflets preventing their normal preventing their normal excursion.excursion.
Abnormalities of the Abnormalities of the Chordae TendineaeChordae Tendineae
•RuptureRupture
•primaryprimary
•infective endocarditisinfective endocarditis
•traumatrauma
•rheumatic feverrheumatic fever
•Lenghtening of the chordal Lenghtening of the chordal structures may occur with MV structures may occur with MV prolapse allowing excessive prolapse allowing excessive billowing of the MV leafletsbillowing of the MV leaflets
Mitral Valve Mitral Valve ProlapseProlapse
•Enlarged leaflet balloons into Enlarged leaflet balloons into left atriumleft atrium
•Midsystolic clicks heardMidsystolic clicks heard
•Valve may become incompetentValve may become incompetent
•Late systolic murmurLate systolic murmur
•3% of population3% of population
•6:4 female:male ratio6:4 female:male ratio
•Most no untoward effectsMost no untoward effects
Mitral valve prolapse
Myxomatous degeneration in a patientMyxomatous degeneration in a patientWith mitral valve prolapseWith mitral valve prolapse
Mitral Valve Mitral Valve Prolapse Prolapse
ComplicationsComplications•Most have no untoward Most have no untoward effects - 3% have effects - 3% have complicationscomplications
•Infectious endocarditisInfectious endocarditis
•Mitral insufficiencyMitral insufficiency
•ArrhythmiasArrhythmias
•Stroke or other systemic Stroke or other systemic infarctinfarct
•Sudden death (very rare)Sudden death (very rare)
Mitral valve prolapse with rupture of chordae tendinae
•Mitral insufficiency: myxomatous Mitral insufficiency: myxomatous degeneration (mitral valve degeneration (mitral valve prolapse), damaged papillary muscle prolapse), damaged papillary muscle due to infarctdue to infarct
•Aortic stenosis: calcification of Aortic stenosis: calcification of normal and congenitally bicuspid normal and congenitally bicuspid aortic valvesaortic valves
•Aortic insufficiency: dilation of Aortic insufficiency: dilation of the ascending aorta, related to the ascending aorta, related to hypertension and aginghypertension and aging