Mitral Valve diseases (Mitral stenosis & Mitral regurgitation) By Mohamed A. Gabr Cardiothoracic surgery specialist Mansoura University Hospitals Mansoura Egypt 2019

1. MITRA
L VALVE
MOHAMED A. GABR
2019

4. The MV
apparatus
6

19. Mitral Valve Diseases
Mitral Stenosis
Mitral Regurgitation

20. Mitral Stenosis

21.  The normal mitral valve orifice area in an adult is 4.0 to 6.0 cm2.
 Most symptomatic patients have a MVA less than 2.5 cm2
Etiology of Mitral Stenosis:
 Rheumatic fever
 Congenital
 Mitral annular calcification
 Infective endocarditis
 Endomyocardial fibroelastosis
 SLE
 Malignant Carcinoid syndrome

22. Grades of Mitral Stenosis
Degree MVA Mean PG PASP
Mild < 2.5 cm2 < 5 mmHg < 30 mmHg
Sever < 1.5 cm2 5 – 10 mmHg > 30 mmHg
Very Sever < 1 cm2 > 10 mmHg > 50 mmHg

26. Hemodynamics

28. Stages

29. Presentation
Symptoms Signs
 Dyspnea
 Cough
 Hemoptysis
 Chest pain 15%
 Palpitations
 Embolic events
 Compression sy.
 Irregular pulse (AF)
 Mitral facies (flush)
 Congested NV
 Orthopnea
 ↑↑ first heart sound
 Mid-diastolic rumble
 Opening snap
 LL edema

32. Evaluation
1- ECHO

33. ECHO “Wilkin`s Score”

41. 2- ECG

43. 3- CXR

44. Treatment options
Medical Intervention
 Diuretics
 Beta Blockers
 Prevention of Thrombo-
embolism
 IE prophylaxis
 Rheumatic fever
prophylaxis
 Mechanical relief of
valve stenosis

47. Closed Mitral Valvotomy
“CMC”

50. Open Mitral Valvotomy
“OMC”

57. Mitral Valve Replacement
“ MVR”

72. Balloon Valvotomy
“ PMBV”

81. Trans-catheter MVR
“ TMVR”

86. Mitral Regurge

87.  MVP
 Rheumatic fever
 Infective endocarditis
 Cardiomyopathy
 Ischemic Heart disease
 Mitral annular calcification
Etiology of Mitral Regurge
Major causes of MRMV apparatus

88. Carpentier Classification of MR

91. Sever Annular dilatation: I Redundant leaflet: II

92. Rheumatic MVD: III Ischemic MR: IV

93. Hemodynamics

94. Stages

95. Presentation
Symptoms Signs
 Fatigue
 Exhaustion
 Dyspnea
 LL edema
 Ascites
 Compression sy.
 Congested NV
 Orthopnea
 ↓↓first heart sound
 Pan-systolic murmur
 LL edema
 Irregular pulse: AF

97. Evaluation
1- ECHO

104. Normal
Degenerated

105. 2- ECG

107. 3- CXR

108. Treatment options
Medical Intervention
 Diuretics
 ACEIs
 Beta Blockers
 Prevention of Thrombo-
embolism
 IE prophylaxis
 Rheumatic fever
prophylaxis
 MV Repair
 MVR

110. Mitral Valve Repair
Open
Trans-catheter

111. Ring Annuloplasty

117. Leaflet Repair

119. Δ
Resection

121. □
Resection

122. Leaflet
Height
Reduction

124. Edge To Edge

127. Leaflet
Augmentation

128. Commissuroplasty

130. Leaflet Reconstruction

131. Chordal Replacement

133. MITRA-CLIP

138. Mitral Valve Replacement
“ MVR”