Mitral Stenosis.. Latest

8/12/2019 Mitral Stenosis.. Latest

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Mitral Valve Regurgitation

Mitral regurgitation involves blood flowing

back from the left ventricle into the left atrium

during systole.

The Leaflets cannot close completely because

the leaflets and chordae tendineae have

thickened andfibrosed resulting in theircontraction.


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Causes

Most common causes in developed

countries:

Mitral Valve prolapse

Ischemia of the left ventricle

Most common cause in developing

countries:Rheumatic Heart Disease and its

sequelae


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Other conditions that lead to

mitral regurgitation:

Myxomatous changes enlarge and

stretch the left atrium and ventricle.

Infective endocarditis may cause

perforation of of leaflet, or scarringfollowing the infection.

Collagen-Vascular disease

Cardiomyopathy

Ischemic disease


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PATHOPHYSIOLOGY:

Problems in one or more leaflets

Choradae tendinae

Elongate Shorten Tear

Papillary MuscleAnnulus

Rupture Stretch Pulled

out of the position

Inability to Contract

Stretched & Deformedby Calcification

Blood regurgitates in the right atrium during diastole

Blood force back in Left artium

Left atrium stretched, hypertrophy and dilate

Blood flowing in R. Atrium Blood going back to lungs

Pulmonary Congestion

Mitral Regurgitation


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Clinical Manifestations Chronic mitral regurgitation is often asymptomatic

but acute mitral regurgitation

(ex. That resulting from mycardial infarction) usually

manifest as severe congestive heartfailure.

Most common Symptoms: Dyspnea

Fatigue

Weakness

Other symptoms:

Palpitation

SOB on exertion

Cough from pulmunary congestion


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Assessment and Diagnostic

Findings

Systolic murmur is heard as high-

pitched, blowing sound at the apex.

Pulse maybe irregular due extrasystolic

beats or atrial fibrillation.


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Doppler echocardiography

used to diagnose and monitor the

progression of mitral regurgitation.


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This color flow Doppler image was recorded in systole. Flow starts in

the left ventricle (LV) beneath the aorta as laminar flow toward the transducer(homogeneous red color). Just before it reaches the upper portion of the

interventricular septum, the color turns gold as it nears a velocity of 0.55

meters/second (the Nyquist limit on the color bar to the left) and then aliases to

turn blue as the velocity exceeds 0.55 meters/second. As it goes through the

defect, it turns a mosaic of colors and projects into the right ventricle (RV). RA,

right atrium.


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Transesophageal

echocardiography

(TEE) provides the best images of mitralvalve


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Medical Management

Patients with mitral regurgitation benifitfrom afterload reduction (arterial dilation)

by treating with:

ACE inhibitors:

Captopril (Capoten)

Enalapril (Vasotech)

Lisinopril (Prinivil,Zestril)

Ramipril (Altace)

Hydralazine (Apresoline)


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Angiotensin converting enzyme

ARBs Lozartan (Cozar) Valsartan (Diovan)

Carvedilol (Coreg)

Once symptoms of heart failure develop, thepatient needs to restrict his/her activity level

to minimize symptoms.

Beta blockers


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Surgical Management

Mitral Valvuloplasty


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Surgical Management

Valve replacement


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Mitral Stenosis

An obstruction of blood flowing from the left

atrium in to the left ventricle.

It is most often cause of rheumatic endocarditis

-thickens mitral valve leaflets and chordaetendineae.

-leaflets often fuse together.

-eventually the mitral valve orifice narrowsand progressively obstructs blood flow into the

ventricles.


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GY:RHEUMATIC ENDOCARDITIS,

Opening narrows to the width of a pencil

resistance to a narrowed orifice in the L.

Atrium / pressure

Poor ventricular filling

Cardiac Output

L. Atrium dilate and

hypertrophy

Pulmonary circulation

becomes congested

Fatigue


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Clinical manifestation

Dyspnea

Progressive Fatigue

Dry cough or wheezing

Hemoptysis Palpitation

Orthopnea

Paroxysmal Nocturnal Dyspnea Repeated Resp. Infections


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Assessment and Diagnostic

Findings

Pulse weak/irregular

Low pitched rumbling diastolic murmur is

heard at the apex.

Atrial dysrhythmias.

Doppler Echocardiography

Electrocardiography (ECG)

Cardiac Catheterization with angiography.


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Medical Management

Anticoagulants to decrease the risk fordeveloping atrial thrombus and may also

require treatment for anemia.

Avoid strenuous activities and competitivesports


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Surgical Mgt. Valvuloplasty

>a procedure in which a narrowed heart valve is stretched openusing a procedure that does not require open heart surgery.

Percutaneous transluminal


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Percutaneous transluminal

valvuloplasty

A balloon tipped catheter is passed from the femoral vein

into the right atrium. From there, it is threaded to the right ventricle

and on to the pulmonic valve, or the atrial septum is punctured for

access to the mitral or aortic valves. When the balloon is positioned

in the valve, a series of inflation-deflation cycles is required to

enlarge the narrowing.


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CommissurotomyIs a surgicalincision of a commissurein the body, as one made in

the heart at the edges of the commissure formed by cardiac valves,

it l l l t
http://en.wikipedia.org/wiki/Surgicalhttp://en.wikipedia.org/wiki/Commissurehttp://en.wikipedia.org/wiki/Cardiac_valvehttp://en.wikipedia.org/wiki/Cardiac_valvehttp://en.wikipedia.org/wiki/Commissurehttp://en.wikipedia.org/wiki/Surgical


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mitral valve replacement

BIOLOGICAL VALVESMECHANICAL VALVES

Mitral valve replacementis a cardiacsurgical procedure in which a patient's

diseased mitral valve is replaced by a

either a mechanical or bioprosthetic valve.


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MECHANICAL VALVES


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The principle advantage of mechanical valves is their excellent durability. The valves

available today simply do not wear out! Their main disadvantage is that blood has a

tendency to clot on all mechanical valves. If this happens the valve will not function

normally. Therefore, patients with these valves must take anticoagulants (blood thinners)

for life. There is also a small but definite risk of blood clots causing stroke, even whentaking anticoagulants.

BIOLOGICAL VALVESThere are a variety of biological alternatives for mitral valve

replacement. Most are made from pig aortic valves. Their key advantage is that they

have a reduced risk of blood clots forming on the valve itself causing valve dysfunction

or stroke. The key disadvantage of biological or tissue valves is that they have morelimited durability as compared with mechanical valves. They will wear out given enough

time. The rate at which they wear out, however, depends on the patient's age. A young

boy might wear out such a valve in only a few years, while the same valve might last 10

years in a middle aged person, and even longer in a patient over the age of 70. Of

course, as we grow older we expect that we will not need the valve for as many years as

our life expectancy is less. The general consensus is that a tissue valve will not need tobe replaced if used in a patient over the age of 70 years.

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