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Valvular Heart Disease

2. Normal Structure Mitral Valve. Cross sectional Area 4-6cm2Anterior and Posterior LeafletsChordae Tendineae ? Papillary Muscles. 3. Mitral Stenosis Etiology

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Valvular Heart Disease

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    1. 1 Valvular Heart Disease Jay L. Rubenstone, D.O., F.A.C.C

    2. 2 Normal Structure Mitral Valve Cross sectional Area 4-6cm2 Anterior and Posterior Leaflets Chordae Tendineae ? Papillary Muscles

    3. 3 Mitral Stenosis Etiology & Pathology Rheumatic Fever- 99% Other Congenital Carcinoid Lupus Amyloid Infective Endocarditis Mucopolysaccharide Disease

    4. 4 Stenotic Pathology Etiology & Pathology Commissural 30% Cuspal 15% Chordal 10% Mixed Remaining Valve becomes funnel shaped or fish mouthed Thickened immobile leaflets or chordal structures

    5. 5 Stenotic Pathology Debate: smoldering rheumatic process or constant blood flow trauma leading to valve fibrosis and thickening

    6. 6 Pathophysiology Mild MS- orifice <2 cm2 Critical MS- <1 cm2 A-V pressure gradient >20mmHg Increased LA Pressure Increase Pulmonary Venous + Capillary Pressures Increase Pulmonary Artery Systolic Pressure Decrease RV Function (when PAS>30-60mmHg)

    7. 7 Pathophysiology Pulmonary HTN Passive Backward Transmission Of Incr. LA pressure ?Pulmonary Arteriolar Constriction ?Organic Obliterative Changes in Pulmonary Vascular Bed ?RV Failure

    8. 8 History Exertional Dyspnea Cough/Wheezing Orthopnea/PND/CHF Hemoptysis-Rupture of Pulm Vein-Brochial Vein Shunts

    9. 9 History Chest Pain-Increase RV Pressures or Unknown Etiology Systemic Emboli (LA clots) Increased LA size, Decreased C.O., Atrial Fib, IE Significantly decreased w/anticoagulation

    10. 10 Physical Exam Ascultation O.S. Dyastolic Rumble Assoc Murmur of MR Loud S1-thickened leaflets Increased P2-pulmonary hypertention Decreased B/P if C.O. decreased Prominent a wave if sinus rhythm present

    11. 11 Physical Exam Mitral Facies-pink, purple facial patches due to decrease CO and systemic vasoconstriction Hepatomegally Edema Ascites Hydrothorax With Right Heart Failure

    12. 12 Diagnosis ECG Left Atrial Abnormality P wave becomes bifid and greater than 0.12 sec in duration in V1 and Lead II RVH- right axis deviation R wave > S wave in V1

    13. 13 Diagnosis Chest X-ray Dilated LA, RA, RV Elevated Left Mainstem Bronchus Interstitial Edema Echo- Cornerstone of Diagnosis Thickened Calcified Leaflets Doming of Leaflets on Opening

    14. 14 Diagnosis Cardiac Catherization Gorlin Equation

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