This document provides an overview of valve disease and surgical interventions. It begins with epidemiology statistics on valve disease prevalence and causes. Next, it covers embryology, anatomy, histopathology, and physiology of the heart valves. The document then reviews the history and progress of surgical interventions for valve disease. It provides details on the surgical management of specific valve diseases, including the aortic, mitral, tricuspid, and pulmonary valves. The document concludes with a brief section on infective endocarditis.

1. Valve disease and surgery
Firas Aljanadi
RVH
26 Nov 2021

2. Subtitles
• Epidemiology
• Embryology, Anatomy ,Histo-pathology, Physiology
• History & progress of surgical interventions /valve choices
• Valve disease and surgical management
▪ Aortic Valve
▪ Mitral Valve
▪ Tricuspid Valve
▪ Pulmonary Valve
▪ Endocarditis
• Q&A

3. Epidemiology
• The prevalence of at least moderate VHD is 2.5% and
increases with age.
• In developed countries, degenerative valve disease has
replaced rheumatic heart disease (RHD) as the leading cause
of valvular heart disease (VHD).
• Mitral regurgitation and aortic stenosis are the most
common VHD in the community and hospital settings,
respectively.
• RHD remains the most common cause of VHD in developing
countries and affects 33.4 million people worldwide.
• The incidence of infective endocarditis has remained stable
at 3 to 7 cases per 100,000 person years,
• Staphylococcus has replaced Streptococcus as the most
common organism.
• The number of adults living with congenital heart disease
has increased significantly in recent decades due to
extraordinary advances in cardiovascular medicine and
surgery.

4. Embryology

6. Patho-Histology
• Stratified into extracellular matrix
ECM layers rich in :
• Elastin (Ventricularis of SL /atrialis
of AV)
• Protoglycan (Spongiosa)
• Collagen (Fibrosa)
• Oriented relative to blood flow

11. Anatomy
MV

12. Anatomy
TV PV

13. Anatomy
AV

15. Physiology
• One way valve

17. History of HVD
surgery
• Before the era of CPB :
• 1925 – Suttar – first successful
digital commisurolysis of
mitral valve
• 1952 – Hufnagel – first
mechanical „ball and cage“
valve implanted to the
descending aorta

21. Mitral Valve
Mitral Regurgitation
MR
• Pathophysiology
• Aetiology
❑ primary secondary
❑Acute chronic
• Symptoms NYHA I-IV CCF,
• Signs
• Investigations
• Surgical options

25. Mitral Stenosis
MS
• Pathophysiology
• Aetiology
• Symptoms
• Signs
• Investigations
• Surgical options

27. Aortic valve
Aortic Stenosis AS
• Pathophysiology
• Aetiology
• Symptoms
• Signs
• Investigations
• Surgical options

30. AR
• Pathophysiology
• Aetiology
• Symptoms
• Signs
• Investigations
• Surgical options

33. Tricuspid valve
• Right-sided isolated native valve
disease is much less common
than left-sided disease
• 1.2% of cases (Euro Heart
Survey)
• Minor right-sided regurgitation
is a common finding on
echocardiography, and within
normal limits.
• TR : majority secondary
• Severe TR :poor prognosis

34. Tricuspid stenosis
(TS)
• Rare in industrially-developed
countries
• 90% results from rheumatic disease. TS
progresses slowly and it frequently co-
exists with left-sided rheumatic valve
disease which may cause symptoms
earlier. TS causes dyspnoea, fatigue and
peripheral oedema
• a mid-diastolic murmur louder on
inspiration and lying down, with a pre-
systolic component in sinus rhythm.
• A giant ‘a wave’ may be seen in the
jugular venous pulse (JVP).

36. Pulmonary Valve

37. Endocarditis

41. Thank you