Mitral valve disease 2020
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1) Mitral stenosis is most commonly caused by rheumatic fever and results in thickening and fusion of the mitral valve leaflets. 2) Symptoms range from none with a valve area over 4cm2 to severe dyspnea with an area less than 1cm2. 3) Treatment involves medications to control heart failure symptoms and rate in atrial fibrillation or mitral balloon valvuloplasty and valve replacement surgery.
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Mitral valve disease 2020
- 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
- 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
- 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
- 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