VHD
VHD
2Faktor Utama yang mempengaruhi Aliran darah pd Kelainan katup
valve area
hydrostatic pressure gradient across the valve
time duration of transvalvular flow3Goals in Management
Regurgitant LesionsReduce or minimize regurgitant flow across the
mitral or aortic valve.
Stenotic LesionsMaximize and enhance stenotic flow across the
mitral or aortic valve4Goals in Management of Various Valvular
LesionsThe valve area in regurgitant lesions can respond to changes
in loading conditions (preload, afterload)
The valve area with stenotic lesions is generally fixedVALVULAR
STENOSISPressure in upstream chamber IS HIGHER than Pressure in
downstream chamber during time of flow (when valve is normally
open). Hemodynamic abnormality = "PRESSURE GRADIENT" UpstreamDown
streamHigh pressurelow pressure6VALVULAR REGURGITATION
UpstreamDown streamVolume overloadRetrograde flow of blood
"upstream" during time when valve is normally closed. Hemodynamic
abnormality = "VOLUME OVERLOAD" 7
LARVRALVVenaCavaAortaPulmArteryPulmVein8RARARVLVAortic
stenosisLVNormal9
LARVRALVVenaCavaAortaPulmArteryPulmVeinAorticInsufficiency
10RARARVLVLVExample: Aortic regurgitation 11
AI
AS
12Heart murmurs 13Systolic MurmursAortic stenosisMitral
insufficiencyMitral valve prolapseTricuspid insufficiency Diastolic
MurmursAortic insufficiencyMitral stenosis S1 S2 S1Common Murmurs
and Timing 14Spectrum of VHD Right Sided VHD Tricuspid
ValveEndocarditis IV drug abusers or inpt with IVsCarcinoid HD -
classically TSTR common, benign, may be secondary to Pulm HTN
Pulmonic ValvePediatrics Pulm StenosisRheumatic HD PI (Graham
Steel Murmur)
Right sided valvular lesions change in intensity with
inspiration15Mitral Valve Disease: EtiologyMitral StenosisRheumatic
- 99.9%!!!CongenitalProsthetic valve stenosisMitral Annular
CalcificationLeft Atrial Myxoma
Acute Mitral RegurgitationInfective endocarditisIschemic Heart
diseasePapillary ms ruptureMitral valve prolapseChordal
ruptureChest trauma
Chronic Mitral RegurgitationIschemic Heart diseasePapillary ms
dysfunctionInferior & posterior MIMitral Valve
prolapseInfective endocarditisRheumaticProstheticMitral annular
calcificationCardiomyopathy
16Mitral StenosisNormal MVA = 4 6 cm2
Mitral Stenosis
Causes:RheumaticCongenitalRheumatoid arthritisSystemic Lupus
ErythematosusCarcinoid Syndrome
Asymptomatic for approximately 20 yearsPresenting symptoms:CHF
(50%)Atrial fibrillation19Mitral Stenosis
Pathophysiology of Mitral StenosisObstruction to LA emptying
Increased LA pressure Increased LA sizeAtrial fibrillationIncreased
pulmonary artery pressureDecreased LV fillingRV overloadIncreased
pulmonary venous pressurePulmonaryedema21Mitral Stenosismild MS: 40
mm * Repeat valvulotomy in 11% of patients in 10 years
Surgery Pulmonic valve replacement for dysplastic valve with
severe stenosis,in Tetralogy of Fallot, and after repairof the
Tetralogy
