It discuss about the defects that occur in the valves of the heart. It may occure due any disease or may be due to any congenital anomaly

1. VALVULAR HEART DISEASE
BY
DR. AURODEEP DASGUPTA (PT)
MPT-CARDIO-THORACIC DISORDERS
MMIPR, MMDU

2. NORMAL HEART
Heart is a muscular structure which is associated with pumping of
blood. It has four chambers – left atrium, left ventricle, right atrium and
right ventricle. Left side of the heart is associated with pumping
oxygenated blood to whole body, while right side of the heart is
associated with pumping deoxygenated blood to the lungs.

3. VALVES
• Valves are structures that restricts back flow of fluids, allows
unidirectional movement of fluid (mainly blood) in human body.
• In human heart, there are 4 valves
• Mitral
• Tricuspid
• Aortic
• Pulmonary

4. VALVULAR APPARATUS
• It is made up of the components which are constituted in a valve, and
they are-
• Fibrous ring
• Leaflets
• Chorda tendinea
• Papillary muscles

5. SUB-VALVULAR APPARATUS
• Chorda tendinea
• Papillary muscles

6. MITRAL VALVE
• Also known as the bicuspid valve/left atrioventricular valve.
• Situated between the left atrium and left ventricle.
• It is made up of two flaps of tissue which opens during left ventricular
diastole and closes during isovolumetric systole of left ventricle.
• Contains 2 leaflets-
• Anterior
• Posterior

8. TRICUSPID VALVE
• Also known as right atrioventricular valve
• Situated between right atrium and right ventricle. Opens during
ventricular diastole and closes during isovolumetric ventricular
contraction.
• Contains 3 leaflets-
• Anterior
• Posterior
• Septal

10. AORTIC VALVE
• Situated between left ventricle and aorta.
• Opens during the left ventricular systole
• It is one of the 2 semilunar valves.
• It has characteristics more similar to the valves found in veins rather than
the heart valves.
• It has 3 cusps-
• Left
• Right
• Posterior

12. PULMONARY VALVE
• Situated between the right ventricle and the pulmonary artery
• It is one of the 2 semilunar valves
• It opens during the right ventricular systole
• It has more characteristics like valves in the veins rather than heart muscle
• It has 3 cusps-
• Left
• Right
• Anterior

14. CHORDA TENDINEA
• These are fibrous tendon like structure which attaches to the leaflets
from papillary muscles.
• These allow force distribution among the leaflets
• Semilunar valves do not contain chorda tendinea

15. MISC.
• Opening and closing of the valves are purely pressure dependent.
• Chorda tendinea inserts in a peculiar manner for effective closing of
the valves.
• Nodules at the tip of the leaflets make the seal tighter.

16. DEFECTS IN THE VALVES
• Stenosis
• Prolapse
• Insufficiency (regurgitation)

17. CAUSES
• Congenital conditions.
• Calcification of the valves.
• Rheumatic heart disease is the most common cause.

18. MITRAL STENOSIS
• Narrowing of the mitral valve occurs mainly due to rheumatic fever in
max. cases (99% of the cases).
• It occurs after years or decades after the patient is suffering from
rheumatic fever.
• MS is a progressive disorder that involves partial opening of the valve
which leads to passage of decreased amount of blood.

20. CAUSES
• Predominantly occurs due to Rheumatic heart disease
• Calcium deposition
• Other causes like
• Congenital defects
• Radiation to the chest
• Autoimmune diseases such as lupus

21. CLINICAL MANIFESTATIONS
• Dyspnea
• Fatigue
• Decreased exercise tolerance
• AF and thromboembolism are also commonly associated with MS and
may be initial presentation.
• S1 more pronounced than S2.

22. DIAGNOSIS
• Clinical findings
• Echocardiography

24. RISK FACTORS
• History of rheumatic fever
• Untreated strep infections

25. COMPLICATIONS
• Pulmonary hypertension
• Heart failure
• Cardiomegaly
• Atrial fibrillation
• Blood clots

26. MANAGEMENT
• Salt restriction
• Limiting exercise
• CCB
• Beta-blockers
• Anticoagulant to reduce thromboembolic risk
• Optimizing volume status with diuretics
• Percutaneous mitral valve balloon valvotomy (PMBV)

27. MITRAL REGURGITATION
• In this condition, back flow of blood occurs. This added volume of
blood in the atrium may cause atrial dilatation which may provoke
atrial fibrillation and additionally, pulmonary pressure may rise.
• Also known as mitral insufficiency.
• Common cause of mild MR is systolic dysfunction and ventricular
dilatation as because it stretches the valve apparatus causing
inefficient closing of the valve.

29. CAUSES
• Mitral valve prolapse
• Ischemia
• Rheumatic fever
• In elderly, it can be occurred due to calcification of the annulus/fibrous
ring.
• Papillary muscle dysfunction after MI.
• Ruptured chordae tendinea.
• Perforated valve due to endocarditis.

30. CLINICAL MANIFESTATION
• MR is generally well tolerated by patients and remain asymptomatic
for years.
• Patient may present with
• Heart failure
• Atrial fibrillation
• Endocarditis
More commonly identified by the presence of murmur
Or as an incidental finding in echocardiography.
Pansystolic murmur at the apex is heard with radiation to the axilla.

31. DIAGNOSIS
• Clinical findings
• Echocardiography

33. MANAGEMENT
• Valve repair or replacement surgery in severe cases.

34. MITRAL VALVE PROLAPSE
• Characterized by mitral valve becoming enlarged and floppy so that
they prolapse back into the left atrium during systole.
• Often associated with connective tissue disorders.
• Usually detected in thin, young women with chest wall abnormalities.
• Usually non progressive and benign, may be associated with
supraventricular and ventricular tachyarrhythmias.

36. CAUSES
• Rheumatic heart disease
• Connective tissue disorder
• Dilatation of the left ventricle

37. CLINICAL MANIFESTATION
• Arrhythmia
• Dizziness and lightheadedness
• Shortness of breath when lying flat or during physical activity
• Fatigue
• Chest pain that is not caused by MI or CAD.

38. OTHER NAMES
• Barlow’s syndrome
• Floppy valve syndrome
• Billowing mitral valve syndrome
• Myxomatous mitral valve syndrome

39. DIAGNOSIS
• Clinical findings and correlations
• Echocardiography

40. RISK FACTORS
• Marfan syndrome
• Ehlers-Danlos anomaly
• Muscular dystrophy
• Graves’ disease
• Scoliosis

41. COMPLICATIONS
• Mitral valve regurgitation
• Arrhythmia
• Endocarditis

43. MANAGEMENT
• Symptomatic management
• Valve replacement surgeries

44. PROSTHETIC VALVES
• Biological
• May from other site of the patient’s
body
• May from other animals(pigs)
• Mechanical
• Metal – stainless steel
• Ceramic
• Silicone
• Polymers – pyrolytic carbon
• Type of valves
• Caged ball
• Tilting Disc
• Bi-leaflets