MITRAL VALVE MITRAL VALVE DISEASESDISEASES

MITRALMITRAL VALVE DISEASESVALVE DISEASES

1. Mitral valve stenosis.

2. Mitral valve regurge.

3. Mitral valve prolapse.

MITRALMITRAL VALVEVALVE STENOSISSTENOSIS

Definition:Definition:

Is the obstruction to diastolic flow of blood through mitral

valve.

CAUSESCAUSES

Rheumatic heart disease 50%Female < Male 9 : 1Congenital heart disease 1%

SYMPTOMS:SYMPTOMS:

1. Dysponea 80%

2. Orthopnea

3. P.N.D.

4.4. HemoptysisHemoptysis

5.5. PalpitationsPalpitations

6.6. Systemic EmbolismSystemic Embolism

7.7. Systemic congestive symptoms 2nd to Systemic congestive symptoms 2nd to increased pul. Art. Pressureincreased pul. Art. Pressure

Congested Neck Veins Congested Neck Veins Rt. Hypochondrial painRt. Hypochondrial pain Swelling of abdomen and Swelling of abdomen and

ankelankel

SIGNS:SIGNS:

Molar flush areaMolar flush area Pulse is normal or small v.Pulse is normal or small v. B.P is normalB.P is normal Palpable first HS (Tapping Palpable first HS (Tapping Apex)Apex)

Loud first heart soundLoud first heart soundOpening snap.Opening snap.Mid-Diastolic rumbling murmur.Mid-Diastolic rumbling murmur.Presystolic accentuation.Presystolic accentuation.Pulmonary signs.Pulmonary signs.Signs in presence of pulmonary Signs in presence of pulmonary

hypertension.hypertension.

E C G:E C G:

Biphasic P-wave atrial activation Biphasic P-wave atrial activation time is increasedtime is increased

C X R:C X R:

• Dil. LA• Dil. Pul. Art.• Pul. Congestion• Pul. Oedema

ECHO:ECHO:Thickend MVL Decrease Mit V. openingMV Area Less than 4 cm2

Dilated left atrium.

2- 4 cm2 Mild MS

1-2 cm2 moderate MS

> cm2 stvere MS

DIFF. DIAGNOSISDIFF. DIAGNOSIS

1. Cary comb murmur

2. Lt. Atrial mexoma

3. Cortriatrium

4. Austen-Flint murmur

COMPLICATIONS:COMPLICATIONS:

1. AF

2. Pulmonary hypertension, RVF

3. Bronchitis

4. Pulmonary infraction

5. Syst. embolism

TREATMENT:TREATMENT:

MEDICAL +++SURGICAL +++

HAEMODYNAMICALLY INSIGIFICANT HAEMODYNAMICALLY INSIGIFICANT MITRAL INCOMPETENCEMITRAL INCOMPETENCE

Click murmur syndrome

or MVP

or Barlow’s Dis.

SYMPTOMS:SYMPTOMS:

AsymptomaticMild chest painPalpitationsMild dyspnoea

Prolapse of Ant. Or Post. Mitral valve leaflet.

ECHO:ECHO:

Normal.

CXR:CXR:

Non- Specific.

ECG:ECG:

SIGNS:SIGNS:

Normal pluse Volume.Normal BP.Late systolic murmur at Apex.Late systolic click.

HAEMODYNAMICALLY HAEMODYNAMICALLY SIGNIFICANT MITRAL SIGNIFICANT MITRAL

INCOMPETENCEINCOMPETENCE

MITRAL INCOMPETENCEMITRAL INCOMPETENCE

endocrditis

Myoc. Infarction

CAUSES:-CAUSES:-

1- ACUTE1- ACUTE

2- CHRONIC:2- CHRONIC:

RRheumatic fever 50%Congenital heart disease ASD marfan’s MVP Coronary A-V fistula

M.V. ring calcificationMyxomatous degeneration.Traumatic heart disease

ACUTE LESIONS:ACUTE LESIONS:Symptoms: * dyspnoea

* palpitations

SIGNS:SIGNS:

Absent 1st HSPan syst. Murmur at mitral area.syst. thrill in 50% of cases.

ECG:ECG:

• Lt V. enlargement• Lt A. enlargement

Enlarged cardiac shadow pul. Congestion

CXR:CXR:

Enlarged LV

Enlarged LA

ECHO:ECHO:

COMPLICATIONS:COMPLICATIONS:

Infect. EndocarditisAcute disruption of mitral valveVent. arrythmia

COMPLICATIONS:COMPLICATIONS:

Systemic embolismEndocarditis

TREATMENTTREATMENT

Prophylactic antibiotic of complications.

Surgical MV repair Surgical MV replacement

Mixed MS + MRMixed MS + MR

dyspnoeaPalpitationsSyst. EmbolismPressure from large LA

SYMPTOMS:SYMPTOMS:

AF

Rheumatic myocarditis

Endocarditis

Syst. Embolism

COMPLICATIONS:COMPLICATIONS:

TREATMENT:TREATMENT:

MV Repair MV Replacement