Mitral Stenosis and Mitral Regurgitation

1. VALVULAR HEART DISEASE

2. MITRAL STENOSIS

4. • Rheumatic fever
99%
ETIOLOGY
• Congenital
1%

7. Opened stenotic mitral valve
showing :
Thickening,
distorted cusps
• Fusion and shortening
of chordae tendinae
Adherent commissures with
calcification and thrombus
deposition, and thickening

8. DILATED LEFT VENTRICLE ?

10. • 6 cm2 NORMAL mitral valve area
• 4 cm2 No symptoms
• 1.5 cm2 Symptoms during exertion, emotional stress, infection,
pregnancy or atrial fibrillation
• <1 cm2 Severe mitral stenosis Dyspneea
CLINICAL PRESENTATION

11. Signs
• Atrial fibrillation
• Mitral facies (abnormal flushing of the cheeks that occurs from cutaneous
vasodilation in the setting of severe mitral valve stenosis)
• Auscultation - Loud first heart sound, opening snap
(created by forceful opening of mitral valve)
- Mid-diastolic murmur (apex)
• Crepitations, pulmonary edema, effusions (raised pulmonary pressure)
CLINICAL PRESENTATION

12. HEART FAILURE

13. Typical distention of the internal jugular vein

22. • ECG: -LAH, right ventricular hypertrophy  tall R waves
• Chest x-ray: - enlarged LA
- signs of pulmonary venous congestion
• ECHO: - thickened immobile cusps
- reduced valve area
- enlarged LA
- reduced rate of diastolic filling of LV
• Doppler: - pressure gradient across mitral valve
• Cardiac catheterization:
- coronary artery disease
- pulmonary artery pressure
- mitral stenosis and regurgitation
PARACLINICAL EXAMINATIONS

24. AORTIC STENOSIS

25. MITRAL STENOSIS

27. • Left atrial outflow tract obstruction:
▫ Atrial myxoma
▫ Thrombus
▫ Large vegetation due to endocarditis
DIFFERENTIAL DIAGNOSIS

29. • Left heart failure
• Right heart failure
• Atrial fibrillation
• Left atrial thrombus
COMPLICATIONS

31. Medically
• Anticoagulant
To reduce the risk of
systemic embolism
• Digoxin, beta blockers,
or rate limiting calcium
antagonists
To control ventricular
rate in atrial fibrillation
• Diuretic, nitrates
To control pulmonary
congestion
Surgically
• Mitral balloon
valvuloplasty***
• Valve replacement
TREATMENT

32. Medically
• Anticoagulant
To reduce the risk of
systemic embolism
• Digoxin, beta blockers,
or rate limiting calcium
antagonists
To control ventricular
rate in atrial fibrillation
• Diuretic, nitrates
To control pulmonary
congestion
Surgically
• Mitral balloon
valvuloplasty***
• Valve replacement
TREATMENT

33. Medically
• Anticoagulant
To reduce the risk of
systemic embolism
• Digoxin, beta blockers,
or rate limiting calcium
antagonists
To control ventricular
rate in atrial fibrillation
• Diuretic, nitrates
To control pulmonary
congestion
Surgically
• Mitral balloon
valvuloplasty***
• Valve replacement
TREATMENT

35. MITRAL REGURGITATION

37. Etiology ?
• 1.Secondary to LV myocardial diseases: DCM, HCM
• 2.Mitral valve prolapse
• 3.Ruptured chordae
• 4.Ischemic papillary muscle dysfunction or
rupture
• 5.Endocarditis
• 6.Collagen vascular diseases and syndromes

38. Etiology
• 1.Secondary to LV myocardial diseases: DCM, HCM
• 2.Mitral valve prolapse
• 3.Ruptured chordae
• 4.Ischemic papillary muscle dysfunction or
rupture
• 5.Endocarditis
• 6. Collagen vascular diseases and syndromes

39. Etiology
• 1.Secondary to LV myocardial diseases: DCM, HCM
• 2.Mitral valve prolapse
• 3.Ruptured chordae
• 4.Ischemic papillary muscle dysfunction or
rupture
• 5.Endocarditis
• 6. Collagen vascular diseases and syndromes

40. Etiology
• 1.Secondary to LV myocardial diseases: DCM, HCM
• 2.Mitral valve prolapse
• 3.Ruptured chordae
• 4.Ischemic papillary muscle dysfunction or
rupture
• 5. Endocarditis
• 6. Collagen vascular diseases and syndromes

41. Etiology
• 1.Secondary to LV myocardial diseases: DCM, HCM
• 2.Mitral valve prolapse
• 3.Ruptured chordae
• 4.Ischemic papillary muscle dysfunction or
rupture
• 5.Endocarditis
• 6. Collagen vascular diseases and syndromes

42. Etiology
• 1.Secondary to LV myocardial diseases: DCM, HCM
• 2.Mitral valve prolapse
• 3.Ruptured chordae
• 4.Ischemic papillary muscle
dysfunction or rupture
• 5.Endocarditis
• 6. Collagen vascular diseases and syndromes

43. Etiology
• 1.Secondary to LV myocardial diseases: DCM, HCM
• 2.Mitral valve prolapse
• 3.Ruptured chordae
• 4.Ischemic papillary muscle dysfunction or
rupture
• 5. Endocarditis
• 6. Collagen vascular diseases and syndromes

44. Etiology
• 1.Secondary to LV myocardial diseases: DCM, HCM
• 2.Mitral valve prolapse
• 3.Ruptured chordae
• 4.Ischemic papillary muscle dysfunction or
rupture
• 5.Endocarditis
• 6. Collagen vascular diseases and syndromes

45. MITRAL VALVE PROLAPSE

46. MITRAL VALVE PROLAPSE

47. PATHOPHYSIOLOGY

50. Medically
• Anticoagulant ??
• Digoxin, beta blockers,
or rate limiting calcium
antagonists
To control ventricular
rate in atrial fibrillation
• Diuretic, nitrates
To control pulmonary
congestion
Surgically
• MITRACLIP
• Valve replacement
TREATMENT

51. Medically
• Anticoagulant ??
• Digoxin, beta blockers,
or rate limiting calcium
antagonists
To control ventricular
rate in atrial fibrillation
• Diuretic, nitrates
To control pulmonary
congestion
Surgically
• MITRACLIP
• Valve replacement
TREATMENT

52. Medically
• Anticoagulant ??
• Digoxin, beta blockers,
or rate limiting calcium
antagonists
To control ventricular
rate in atrial fibrillation
• Diuretic, nitrates
To control pulmonary
congestion
Surgically
• MITRACLIP
• Valve replacement
TREATMENT