Valvular Heart Diseasedr Putra Hendra SpPDUNIBA

Cardiac Anatomy 101

Spectrum of VHD Aortic Valve Mitral Valve Tricuspid Valve Pulmonic Valve

Spectrum of VHD Regurg Aortic Valve Stenosis Regurg Mitral Valve Stenosis Regurg Tricuspid Valve Stenosis Regurg Pulmonic Valve Stenosis

Spectrum of VHD RegurgAcuteAortic ValveChronicStenosisAcuteChronicRegurgAcuteMitral ValveChronicStenosisAcuteChronicRegurgAcuteTricuspid ValveChronicStenosisAcuteChronicRegurgAcutePulmonic ValveChronicStenosisAcuteChronic

Mitral 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 calcificationCardiomyopathyLV dilatationIHSS

Valvular Heart DiseaseMitral Valve

Mitral RegurgitationMitral Stenosis

Mitral RegurgitationEtiologies

Alterations of the Leaflets, Commissures, AnnulusRheumaticMVPEndocarditis

Alterations of LV or LA size and FunctionPapillary Muscle (Ischemic, MI, Myocarditis, DCM)HOCMLV Enlargement Cardiomyopathies - LA Enlargement from MR MR begets MR

Mitral Regurg pathophysiology

Mitral Regurg pathophysiology

Mitral Regurg pathophysiology

Mitral RegurgitationSymptoms

Fatigue and weakness Dyspnea and orthopneaRight sided HFMVP Syndrome (if present)

Mitral RegurgitationPhysical Exam

Holosystolic Apical Blowing Murmur Laterally displaced apical impulseSplit S2 (but is obscured by the murmur)S3 Gallop (increased volume during diastole)Radiation depends on the etiology

Mitral Regurgitation- SBE Prophylaxis

Mitral Regurgitation

Mitral Regurgitation -MVP

Mitral Regurgitation -MVP

Mitral StenosisEtiologiesRheumatic almost all cases in adultsMitral Annular Ca+ - massive (rare)Congenital rare

60% of pts dont have a history of ARC50% of pts who have ARC dont develop VHD

Mitral Stenosis

Mitral Stenosis

Mitral Stenosis

Mitral StenosisPhysical ExamLoud S1Opening SnapDiastolic Apical Rumble (murmur)May be associated with:MR or ASRight Sided MurmursPI Graham Steel MurmurTR

Mitral StenosisTreatment of Symptomatic Mitral Stenosis

Medical Therapy treats the symptoms not the causeDiuretics for congestionDigoxin, Beta and Ca Channel Blockers for Afib rate controlAnticoagulation for AFib and LA clotsSBE Prophylaxix prevent endocarditis

Mitral StenosisTreatment of Symptomatic Mitral Stenosis

Surgical Therapy treats the causePercutaneous Ballon Valvulaoplasty Non-calcified, pliable valve

Balloon Mitral Commissurotomy

Mitral StenosisTreatment of Symptomatic Mitral Stenosis

Surgical Therapy treats the causeOpen Commisurotomy valve repairMitral Valve Replacement

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