Acquired valvular heart diseases with x ray findings

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  • calcification
  • Aortic Stenosis. Frontal radiograph on left demonstrates isolated enlargement of the ascending aorta (white arrow). The left ventricle is enlarged (red arrow) and the heart is mildly enlarged overall. The lateral view on the right demonstrates calcifications in the region of the aortic valve leaflets (circle). generally, the aortic valve lies above a line drawn from the carina to the junction of the diaphragm with the anterior chest wall. The mitral valve lies below the line.
  • Enlarged left ventricle + enlargement of entire aorta
  • LVH and dilated ascending aorta(dilated aortic configuration)
  • Straightening of the left heart border
  • Convexity from enlarged left atrial appendage
  • Small aortic knob
  • Right atrial enlargement from TR and Left atrial enlargement from MS
  • cephalization
  • cephalization
  • Enlarged MPA and straightening of left heart border due to enlarged left atrium
  • Markedly enlarged heart, large LA, normal pulmonary vasculature.
  • MS and MR
  • Enlarged LPA and MPA and normal size heart---PS
  • TS-prominent rt heart border
  • Acquired valvular heart diseases with x ray findings

    1. 1. Role of chest x-ray in Acquired valvular heart diseases
    2. 2. • There is a wide variety of structural change that can affect the heart valves, but in terms of their function valvular disease can either be pure stenosis or pure regurgitation, or more likely a combination of both.
    3. 3. • The appreciation of the dynamics of flow through the cardiac chambers is important and allows the interpreter to assess from the features on the radiograph exactly what changes are occurring at the valvular level.
    4. 4. AORTIC STENOSIS
    5. 5. Aortic Stenosis Frequency of Causes Most often as result of degeneration of bicuspid aortic valve Less commonly, 2° to degeneration of tricuspid aortic valve in person > 65 Even less commonly, 2° rheumatic heart disease in tricuspid aortic valve
    6. 6. Aortic Stenosis X-Ray Findings Depends on age patient/severity of disease • In infants, AS CHF/pulmonary edema • In adults – Normal heart size Until cardiac muscle decompensates LVH – Enlarged ascending aorta 2° post-stenotic dilatation 2° turbulent flow – Normal pulmonary vasculature
    7. 7. Post-stenotic Dilatation of Aorta Results due to the impact of the stenotic jet on the vessel wall Variable as the jet itself vary in direction from patient to patient
    8. 8. Does not correlate with the degree of stenosis Difficult to be detected in older patients aorta becomes unfolded and slightly dilated
    9. 9. Prominence of ascending aorta from post stenotic dilatation
    10. 10. Prominence of ascending aorta from post stenotic dilatation
    11. 11. Calcification in the position of Aortic valve An important sign On lateral film Usually indicates hemodynamically significant AS Calcification of valve usually indicates gradient across valve of > 50mm Hg
    12. 12. In most cases Pulmonary vascularity is normal But in advanced cases Left ventricular impairment and associated changes of heart failure
    13. 13. AORTIC REGURGITATION
    14. 14. Aortic Regurgitation Causes  Rheumatic heart disease  Marfan’s  Luetic aortitis  Ehlers-Danlos syndrome  Endocarditis  Aortic dissection
    15. 15. Aortic Regurgitation X-Ray Findings A large heart with predominantly left ventricular configuration The ascending aorta and often the aortic arch are large and can sometimes be visualized as a bulge on the right of the mediastinum
    16. 16. No Calcification in pure aortic regurgitation unless there is combination of stenosis and regurgitation
    17. 17. Combination of a large left ventricle, no other chamber enlargement and normal pulmonary vessels is very suggestive of severe chronic aortic regurgitation
    18. 18. Enlarged left ventricle + enlargement of entire aorta in AR
    19. 19. LVH and dilated ascending aorta(dilated aortic configuration)
    20. 20. MITRAL STENOSIS LEFT ATRIAL OUTFLOW OBSTRUCTION
    21. 21. Rheumatic heart disease causes mitral stenosis in 99.8% of cases
    22. 22. The reduction of flow occurs as a result of fusion of leaflet commisures In addition, thickening of the valve leaflets occurs with shortening and thickening of the chordae tendinae which further restricts valve movement
    23. 23. The symptoms of flow restriction (dyspnea and heart failure) may be few until the valve become critically narrowed The condition leads to thrombus formation in left atrium and consequent systemic embolus.
    24. 24. Course of Mitral Stenosis  Mitral stenosis occurs  Left atrial pressure ↑  Left atrium enlarges  Cephalization  PIE  PAH develops
    25. 25.  PVR increases  RV enlarges  Pulmonic regurg develops  Tricuspid annulus dilates  Tricuspid insufficiency  RV failure
    26. 26. Chest X-Ray Findings in Mitral Stenosis Usually normal or slightly enlarged heart Straightening of left heart border convexity along left heart border 2° to enlarged atrial appendage
    27. 27. Small aortic knob from decreased cardiac output Double density of left atrial enlargement Rarely, right atrial enlargement from tricuspid insufficiency
    28. 28. Chest X-Ray Findings in MS…Calcifications Calcification of valve-not annulus-seen best on lateral film Rarely, calcification of left atrial wall 2° fibrosis from long-standing disease Rarely, calcification of pulmonary arteries from PAH
    29. 29. Chest X-Ray Findings in MS…Pulmonary findings Cephalization Elevation of left mainstem bronchus Enlargement of main pulmonary artery 2° pulmonary arterial hypertension – Severe, chronic disease Multiple small hemorrhages in lung – Pulmonary hemosiderosis
    30. 30. Straightening of the left heart border
    31. 31. Convexity from enlarged left atrial appendage
    32. 32. Small aortic knob
    33. 33. Right atrial enlargement from TR and enlarged Left atrial appendage from MS
    34. 34. cephalization
    35. 35. cephalization
    36. 36. Enlarged MPA and straightening of left heart border due to enlarged left atrium
    37. 37. Mitral annulus Calcification Calcification of mitral annulus does not signify presence of mitral valve disease • Occurs in older women • Usually asymptomatic
    38. 38. MITRAL REGURGITATION
    39. 39. Mitral Regurgitation Causes Thickening of valve leaflets 2°rheumatic disease Rupture of the chordae – Posterior leaflet more often-Trauma, Marfan’s Papillary muscle rupture or dysfunction – Acute myocardial infarction
    40. 40. LV enlargement dilatation of mitral annulus – Any cause of LV enlargement LV aneurysm valvular dysfunction – Acute myocardial infarction
    41. 41. The acute lesion of rheumatic fever is mitral regurgitation, not stenosis The largest left atria ever are produced by mitral regurgitation, not mitral stenosis
    42. 42. X-Ray Findings in MR In acute MR – Pulmonary edema – Heart is not enlarged
    43. 43. In chronic MR • LA and LV are markedly enlarged – Volume overload • Pulmonary vasculature is usually normal – LA volume but not pressure is elevated
    44. 44. Markedly enlarged heart and large LA
    45. 45. MS MR
    46. 46. PULMONARY VALVE STENOSIS
    47. 47. It is very rare to see acquired disease of the pulmonary valve Carcinoid disease and endocarditis can occasionally affect the valve
    48. 48. X-Ray Findings in pulmonic valve stenosis Enlarged main pulmonary artery Enlarged left pulmonary artery (jet effect) Normal to decreased peripheral pulmonary vasculature Rare calcification of pulmonary valve in older adults
    49. 49. Enlarged LPA and MPA and normal size heart---PS
    50. 50. TRICUSPID VALVE DISEASE
    51. 51. • Tricuspid stenosis (TS) is usually due to rheumatic fever and is usually seen in association with left heart valve disease • TS is also sometimes associated with carcinoid syndrome
    52. 52. • Tricuspid regurgitation (TR) is usually secondary to right ventricular dilatation as in pulmonary vascular disease. • Primary TR is less common and usually caused by rheumatic heart disease or infective endocarditis (heart valve infection).
    53. 53. • Chest x-ray may show right atrial bulge in either condition
    54. 54. TS-prominent right heart border
    55. 55. THANKS

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