Valvular Heart Diseases - Final Year Lecture

ByMr. Adeel ABBAS

Valvular Heart Disease is defined as any disease process involving one or more of the four valves of the heart, resulting in deranged blood flow through the heart chambers.

Rheumatic Fever

What is the Common Age of Presentation?

In developing countries, common age of presentation is 5 to 15 years.

In developed countries, common age of presentation is middle age.

How Rheumatic Fever Starts?

Rheumatic Fever starts after infection with

Group A α-Hemolytic Streptococcus leading

to pharyngitis. Then there is Immune-

mediated acute inflammation affecting heart

valves due to cross-reaction between antigens

of bacteria and cardiac protiens.

What are the Pathological Effects?

May make Orifice Smaller…May make Orifice Unable to Close Properly…

Stenosis causes Pressure Load…Regurgitation causes Volume Load…

Jones Criteria

Cardiac SequelaeMitral Valve 70%.Aortic Valve 28%.Tricuspid Valve 10%.Pulmonary Valve 2%.

PreventionPrompt treatment for a sore throat that lasts

longer than 48 hours, especially if accompanied by a fever.

Timely administration of antibiotics may prevent the development of rheumatic fever which can cause valvular heart disease.

Let’s first understand Cardiac Cycle along-

with Venous Wave, EKG and Heart Sounds….

Mitral RegurgitationCauses;

Degenerative.Rheumatic Fever.Infective Endocarditis.

Presentation;Dyspnoea.Chronic Fatigue.Palpitation.Pulmonary Edema.

Apex Laterally Displaced.

Apical Pansystolic Murmur Radiating to Axilla

Mitral StenosisCauses;

Rheumatic Fever.Congenital.

Presentation;Paroxysmal Nocturnal Dyspnoea.Malar Flush.Pulmonary Hypertension.Atrial Fibrillation.

Aortic RegurgitationCauses;

Congenital.Rheumatic Fever.Infective Endocarditis.

Presentation;Dyspnoea.Palpitation.Wide Pulse Pressure.Water Hammer Pulse

Aortic StenosisCauses;

Senile Degenration.Rheumatic Fever.Congeital.

Presentation;Angina Pectoralis.Dizziness/Syncope.LHFSlow Rising Pulse.

InvestigationsECG.Chest X-Ray.Echocardiogram.

Dilated Right Atrium

Massively Dilated Right Atrium

ManagementMedical.

SurgicalRepair.Replacement.

Medical TreatmentHeart-healthy Lifestyle;

Don’t smoke.Avoid excessive alcohol consumption.Avoid Excessive salt intake.Reduce Exercise.

Symptomatic;Long-term antibiotic therapy.Antithrombotic Medications (Aspirin).More potent anticoagulants (Warfarin).Treat Cardiac Failure.Digitalis (for Atrial Fibrillation).

Surgical TreatmentIndicatons;

Symptomatic Status, Occurrence of Thromboembolic episodes or

Endocarditis, Deterioration in Pulmonary Haemodynamics,Deterioration in Myocardial function. 

Surgical OptionsValve Repair (Possible only in A/V valves);

Valvotomy.Balloon Dilatation.

Valve Replcement;Mechanical Valves (Require Lifelong

Anticoagulation).Biological Valves (Last for 10-15 years & Donot

Require Lifelong Anticoagulation).

Metallic Valves

Biological Valve

Operative Picture of Valve Replacement