Valvular Heart DISEASE
What is Valvular Heart Disease?
What Are the Types of Valve
Disease?
• There are several types of valvular
heart disease, include:
• 1)Valvular stenosis: When a valve
opening is smaller than normal
• 2)Valvular
Insufficiency/REGURGITATION:
occurs when a valve does not close
tightly, thus allowing blood to leak
backwards.
• Both valvular diseases can involve all
four valves.
Types
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Mitral Stenosis
Mitral Regurgitation
Aortic Stenosis
Aortic regurgitation
Tricuspid valve is affected infrequently
– Tricuspid stenosis – causes Rt HF
– Tricuspid regurgitation
• Pulmonary valve disease
What Causes Valvular Disease?
• Congenital : mostly affect the aortic or pulmonic
valve ,
• Acquired :.
• Other Acquired causes?
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Rheumatic fever
Infective endocarditis
Coronary artery disease
Heart attack
Cardiomyopathy (heart muscle disease)
Syphilis .
Hypertension .
Aortic aneurysms .
Connective tissue diseases
Rheumatic Heart Disease
• Inflammatory process that may affect the
myocardium, pericardium and or
endocardium
• Usually results in distortion and scarring of
the valves
• Caused by a type 2 inflammatory reaction
secondary to sore throat caused by a
bacteria called S.pyogenes
Rheumatic Heart Disease, cont.
– Prior history of
rheumatic fever
– General malaise
– Pain – may or may
not be present
–
– Murmurs
– Dyspnea
– polyarthritis
Infective endocarditis
• Infection of heart
valves
• Commonly bacterial
• Results in damage
to valve structure
giving rise to
senosis or
regurgitation
Mitral Stenosis
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Usually results from rheumatic carditis
Is a thickening by fibrosis or calcification
Can be caused by tumors, calcium and thrombus
Valve leaflets fuse
These narrows the opening and prevents normal blood
flow from the LA to the LV
• LA pressure increases, left atrium dilates, PAP
increases, and the RV hypertrophies
• Pulmonary congestion and right sided heart failure
occurs
• Followed by decreased preload and CO decreases
Mitral Stenosis, cont.
• Mild – asymptomatic
• With progression – dyspnea, orthopneas, dry
cough, hemoptysis, and pulmonary edema may
appear
• Right sided heart failure symptoms occur later
• Signs
– Atrial fibrillation
– Apical diastolic murmur is heard
aortic stenosis
• characterized by an abnormal
narrowing of the aortic valve
opening.
Causes of Aortic Valve Stenosis
1)Most commonly, aortic stenosis is due to
age-related progressive calcification
3)Rheumatic aortic stenosis(10%)
Clinical presentation
• Congestive heart
failure
• Syncope
• Angina
Aortic Regurgitation
• is the leaking of the aortic valve of the
heart that causes blood to flow in the
reverse direction during ventricular
diastole, from the aorta into the left
ventricle.
• Causes:
• Infective endocarditic
• Rheumatic disease
• Trauma
• Aortic dilatation like in Marfan’s
Syndrome, syphilis
Mitral Stenosis
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Usually results from rheumatic carditis
Is a thickening by fibrosis or calcification
Can be caused by tumors, calcium and thrombus
Valve leaflets fuse
These narrows the opening and prevents normal blood
flow from the LA to the LV
• LA pressure increases, left atrium dilates, PAP
increases, and the RV hypertrophies
• Pulmonary congestion and right sided heart failure
occurs
• Followed by decreased preload and CO decreases
Mitral Stenosis, cont.
• Mild – asymptomatic
• With progression – dyspnea, orthopneas, dry
cough, hemoptysis, and pulmonary edema may
appear
• Right sided heart failure symptoms occur later
• Signs
– Atrial fibrillation
– Apical diastolic murmur is heard
Mitral regurgitation :
-occurs when the mitral valve does
not close properly while the heart
pumps out blood .
-Most common cause is mitral valve
prolapse (MVP) .
-Pathophysiology ; blood leaks
back into LA> dilatation of LA
>reduction in LV systolic
function>later LV dilatation.
-symptoms are (palpitationdyspnea- edema- fatigue- ascitis)
diagnostic tests
• Echocardiography .
• Transesophageal
echocardiography .
• Cardiac catheterization
.(also called an
angiogram)
• MRI
Treatment of valvular heart
disease
• Drugs to facilitate myocardial functioning
• Surgical-valve replacement/valve repair
Medial Treatment
• Nonsurgical management focuses on drug
therapy and rest
• Diuretic, beta blockers, digoxin, O2,
vasodilators, prophylactic antibiotic
therapy
• Manage atrial fibrillation , if develops, with
conversion if possible, and use of
anticoagulation
Surgical Management of Valve
Disease
• Mitral Valve
– Mitral Valve Replacement
– Balloon Valvuloplasty
• Aortic Valve Replacement
Baloon valvuloplasty
Mechanical Valve
Mechanical Valve
Tissue Valve
Advantages of surgical repair
• Reducing progression into heart faliure
• better functional outcome
Disadvantages
• Valve failure
• Some valves warrant life long
anticoagulatioln
Thank you….