Vitium(valvular heart diseases and shunts)

Dr. Attila Zalatnai

Anatomical malformations + Valvular heart diseases

Congenital heart defects: Etiology:90 % multifactorialgenetic causes (Down-sy); exogeneous: chronic alcoholism….

PERSISTENT TRUNCUS

ARTERIOSUS

PATENT DUCTUS BOTALLI

ATRIAL SEPTAL DEFECTS (ASD)

Small opening: occurs in 20% of people

Larger opening: left-to-right shunt

pulmonary hypertension

right chamber hypertrophy

right-sided heart failure

Cyanosis: late event

Most severe form: one single, common atrium

VENTRICULAR SEPTAL DEFECTS (VSD)

Most common cardiac malformation

Mostly at the upper (membranous) part

Left-to-right shunt

Smaller ones: spontaneous closure is expected

Larger ones: pulmonary hypertension

TETRALOGY of FALLOT

1. Ventricular septal defect

2. Pulmonary stenosis

3. Right ventricle hypertrophy

4. Aortic dextroposition

Relatively frequent in diabetics

Right-to-left shunt

Cyanosis since birth

Susceptibility to endocarditis

Valvular heart diseases

Congenital or acquired

Mainly the left side of the heart is involved

Right-sided forms: mainly secondary, functional or in carcinoid heart

Susceptibility to infective endocarditis

Etiology: degenerative (atherosclerosis)rheumatic feverSLE infectionsmyxoid degeneration

Aortic stenosisAortic insufficiencyMitral stenosisMitral insufficiencyCombined

Aortic stenosis

Severe left ventricular hypertrophy

Aortic insufficiency

Mitral stenosis

Arteficial valve thrombosis

Endocarditis: inflammation of the endocardium, especially the

valves

1. Infective endocarditis: (bacteria, fungi)

Predisposing factors:

- septicemia

- valve malformations

- deformed, calcified valves

- arteficial valve implantation

- previous rheumatic fever

- peridontal, periapical foci!

Most important causative agents:

Strcc. viridans

Enterococcus (Str. fecalis)

Staphylococcus aureus

Candida species

Morphology:

Vegetations

Valve destruction

Both

Complications:

embolization (septic emboli, septic abscesses)

sepsis

„mycotic aneurysms”, subarachnoidal hemorrhage

acute left sided heart failure (regurgitation, chorda tendinea rupture)

healing by scarring and calcification

VITIUM

stenosis insufficiency combined

2. Non-infective endocarditis:

verrucous endocarditis (rheumatic fever)

SLE (Libman-Sacks endocarditis) – atypical

„marantic” endocarditis - paraneoplastic

Chronic obstructive lung diseases.

Cor pulmonale.

Chronic obstructive lung disease,

Chronic obstructive pulmonary disease, COPD

• diseases characterized by the presence of airflow obstruction

(expiration is impaired)

• airflow obstruction generally is progressive

• permanent structure destruction of the affected tissues

chronic bronchitis

emphysema

bronchiectasis

(bronchial asthma) (?)

Clinical definition of the chronic bronchitis:

presence of a chronic productive cough for 3 months during each of 2

consecutive years (other causes of cough being excluded).

Vast majority of cases are attributed to cigarette smoking, minority is due

to air pollution

Simple chronic bronchitis

Chronic mucopurulent bronchitis

Chronic bronchitis with exacerbation

Chronic bronchitis: pathology

• goblet cell metaplasia in the bronchioles

• mucous gland hyperplasia (Reid-index )

• mucous plugging in the small bronchi, bronchioles

• smooth muscle hypertrophy

• neutrophilic infiltrate accumulation

• continuous inflammation, mucopurulent exudate

• tissue destruction

• fibrosis of the brochial wall

• atrophy of the mucous membrane

• permanent dilatation of the small bronchi (distal to

the segmental bronci)

• pulmonalsclerosis

Emphysema:

• abnormal, permanent enlargement of the air spaces distal to the

terminal bronchioles, accompanied by destruction of their walls and

without obvious fibrosis

• commonly presents with chronic bronchitis

E K

Forms of the emphysema:

Centriacinar: focal destruction limited to the respiratory bronchioles and

the central portions of acinus. This form of emphysema is associated

with cigarette smoking and is most severe in the upper lobes.

Panacinar: involves the entire alveolus distal to the terminal bronchiole.

The panacinar type is most severe in the lower lung zones and generally

develops in patients with homozygous alpha1-antitrypsin (AAT)

deficiency

Paraseptal: least common form and involves distal airway structures,

alveolar ducts, and sacs. This form of emphysema is localized to fibrous

septa or to the pleura and leads to formation of bullae

Etiology:

Cigarette smoking (neutrophil activation, proteinase, elastase activities,

blocking the antiproteinase system)

Alpha-1-antitrypsin deficiency

bullous emphysema

Cor pulmonale:

Hypertrophy and/or dilatation of the right side of the heart as a result

of pulmonary hypertension (valve diseases, left heart problems

excluded!!)

1. Acute cor pulmonale (massive pulmonary embolus, air embolia,

amniotic fluid embolisation)

2. Chronic cor pulmonale

a. diseases of the lung parenchyma

(chronic bronchitis, emphysema, bronchiectasis, lung fibrosis,

sarcoidosis, massive tbc, asbestosis)

b. diseases of the chest wall impairing the respiration

(kyphoscoliosis, pleural callus, extreme obesity)

c. diseases of the lung vasculature

(multiplex pulmonary microembolisation)

Acute cor pulmonale – saddle embolus

R

septum

L

asbestosis

(Boeck) sarcoidosis

Consequences of right ventricular dilatation

(right sided heart failure)

Cyanosis

Hydrothorax

Hydropericardium

Ascites

Anasarca / generalized edema

Hepatosplenomegaly

Nutmeg liver

Congestion (passive hyperemia) of the internal organs

Congestive gastritis/duodenitis