Valvular Heart DISEASE

What is Valvular Heart Disease?

What Are the Types of Valve Disease?

• There are several types of valvular heart disease, include:

• 1)Valvular stenosis: When a valve opening is smaller than normal

• 2)Valvular Insufficiency/REGURGITATION: occurs when a valve does not close tightly, thus allowing blood to leak backwards.

• Both valvular diseases can involve all four valves.

Types

• Mitral Stenosis• Mitral Regurgitation• Aortic Stenosis• Aortic regurgitation• Tricuspid valve is affected infrequently

– Tricuspid stenosis – causes Rt HF– Tricuspid regurgitation

• Pulmonary valve disease

• Congenital : mostly affect the aortic or pulmonic valve ,

• Acquired :.

• Other Acquired causes?• Rheumatic fever

• Infective endocarditis

• Coronary artery disease

• Heart attack

• Cardiomyopathy (heart muscle disease)

• Syphilis .

• Hypertension .

• Aortic aneurysms .

• Connective tissue diseases

What Causes Valvular Disease?

Rheumatic Heart Disease

• Inflammatory process that may affect the myocardium, pericardium and or endocardium

• Usually results in distortion and scarring of the valves

• Caused by a type 2 inflammatory reaction secondary to sore throat caused by a bacteria called S.pyogenes

Rheumatic Heart Disease, cont.– Prior history of

rheumatic fever– General malaise– Pain – may or may

not be present

– – Murmurs– Dyspnea– polyarthritis

Infective endocarditis • Infection of heart

valves • Commonly bacterial • Results in damage

to valve structure giving rise to senosis or regurgitation

Mitral Stenosis

• Usually results from rheumatic carditis• Is a thickening by fibrosis or calcification• Can be caused by tumors, calcium and thrombus • Valve leaflets fuse• These narrows the opening and prevents normal blood

flow from the LA to the LV• LA pressure increases, left atrium dilates, PAP

increases, and the RV hypertrophies• Pulmonary congestion and right sided heart failure

occurs• Followed by decreased preload and CO decreases

Mitral Stenosis, cont.

• Mild – asymptomatic• With progression – dyspnea, orthopneas, dry

cough, hemoptysis, and pulmonary edema may appear

• Right sided heart failure symptoms occur later • Signs

– Atrial fibrillation – Apical diastolic murmur is heard

aortic stenosis

• characterized by an abnormal narrowing of the aortic valve opening.

Causes of Aortic Valve Stenosis

1)Most commonly, aortic stenosis is due to age-related progressive calcification

3)Rheumatic aortic stenosis(10%)

Clinical presentation

• Congestive heart failure

• Syncope• Angina

Aortic Regurgitation

• is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle.

• Causes:• Infective endocarditic• Rheumatic disease• Trauma• Aortic dilatation like in Marfan’s

Syndrome, syphilis

Mitral Stenosis

• Usually results from rheumatic carditis• Is a thickening by fibrosis or calcification• Can be caused by tumors, calcium and thrombus • Valve leaflets fuse• These narrows the opening and prevents normal blood

flow from the LA to the LV• LA pressure increases, left atrium dilates, PAP

increases, and the RV hypertrophies• Pulmonary congestion and right sided heart failure

occurs• Followed by decreased preload and CO decreases

Mitral Stenosis, cont.

• Mild – asymptomatic• With progression – dyspnea, orthopneas, dry

cough, hemoptysis, and pulmonary edema may appear

• Right sided heart failure symptoms occur later • Signs

– Atrial fibrillation – Apical diastolic murmur is heard

Mitral regurgitation : -occurs when the mitral valve does

not close properly while the heart pumps out blood .

-Most common cause is mitral valve prolapse (MVP) .

-Pathophysiology ; blood leaks back into LA> dilatation of LA >reduction in LV systolic function>later LV dilatation.

-symptoms are (palpitation- dyspnea- edema- fatigue- ascitis)

diagnostic tests

• Echocardiography .• Transesophageal

echocardiography . • Cardiac catheterization .

(also called an angiogram)

• MRI

Treatment of valvular heart disease

• Drugs to facilitate myocardial functioning

• Surgical-valve replacement/valve repair

Medial Treatment

• Nonsurgical management focuses on drug therapy and rest

• Diuretic, beta blockers, digoxin, O2, vasodilators, prophylactic antibiotic therapy

• Manage atrial fibrillation , if develops, with conversion if possible, and use of anticoagulation

Surgical Management of Valve Disease

• Mitral Valve– Mitral Valve Replacement– Balloon Valvuloplasty

• Aortic Valve Replacement

Baloon valvuloplasty

Mechanical Valve

Mechanical Valve

Tissue Valve

Advantages of surgical repair

• Reducing progression into heart faliure

• better functional outcome

Disadvantages

• Valve failure

• Some valves warrant life long anticoagulatioln

Thank you….