Valvular Heart DISEASE

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Valvular Heart DISEASE
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What is Valvular Heart Disease?
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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.

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Types

• Mitral Stenosis
• Mitral Regurgitation
• Aortic Stenosis
• Aortic regurgitation
• Tricuspid valve is affected infrequently
• Tricuspid stenosis causes Rt HF
• Tricuspid regurgitation
• Pulmonary valve disease

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What Causes Valvular 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

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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

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Rheumatic Heart Disease, cont.

• Prior history of rheumatic fever
• General malaise
• Pain may or may not be present

• Murmurs
• Dyspnea
• polyarthritis

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Infective endocarditis

• Infection of heart valves
• Commonly bacterial
• Results in damage to valve structure giving rise
  to senosis or regurgitation

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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

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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

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aortic stenosis

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

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Causes of Aortic Valve Stenosis

• 1)Most commonly, aortic stenosis is due to
  age-related progressive calcification
• 3)Rheumatic aortic stenosis(10)

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Clinical presentation

• Congestive heart failure
• Syncope
• Angina

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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 Marfans Syndrome,
  syphilis

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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

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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

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• 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 LAgt
  dilatation of LA gtreduction in LV systolic
  functiongtlater LV dilatation.
• -symptoms are (palpitation- dyspnea- edema-
  fatigue- ascitis)

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diagnostic tests

• Echocardiography .
• Transesophageal echocardiography .
• Cardiac catheterization .(also called an
  angiogram)
• MRI

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Treatment of valvular heart disease

• Drugs to facilitate myocardial functioning
• Surgical-valve replacement/valve repair

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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

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Surgical Management of Valve Disease

• Mitral Valve
• Mitral Valve Replacement
• Balloon Valvuloplasty
• Aortic Valve Replacement

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Baloon valvuloplasty
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Mechanical Valve
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Mechanical Valve
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Tissue Valve
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Advantages of surgical repair

• Reducing progression into heart faliure
• better functional outcome
• Disadvantages
• Valve failure
• Some valves warrant life long anticoagulatioln

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Thank you.