Valvular Heart Disease PDF

VALVULAR HEART DISEASE Alina Trandafir, MD Assoc. Prof. Cristian Guţu, MD, PhD Classification: 1. MITRAL valve a) Mitral Stenosis b) Mitral Regurgitation 2. AORTIC valve a) Aortic stenosis b) Aortic regurgitation  MITRAL STENOSIS  Mitral ste...

VALVULAR HEART DISEASE Alina Trandafir, MD Assoc. Prof. Cristian Guţu, MD, PhD Classification: 1. MITRAL valve a) Mitral Stenosis b) Mitral Regurgitation 2. AORTIC valve a) Aortic stenosis b) Aortic regurgitation  MITRAL STENOSIS  Mitral stenosis is commonly due to rheumatic heart disease following previous rheumatic fever due to infection with a group A β-haemolytic streptococcus;  Other causes of mitral stenosis include: congenital mitral stenosis Lutembacher’s syndrome (the combination of acquired mitral stenosis and an atrial septal defect) mitral annular calcification, rarely; this may lead to mitral stenosis if extensive, particularly in elderly patients and those with end-stage renal disease carcinoid tumors metastasizing to the lung, or primary bronchial carcinoid  Pathophysiology  When the normal valve orifice area of 4–6 cm2 is reduced to less than 1 cm2, severe mitral stenosis is present. In order for sufficient cardiac output to be maintained, the left atrial pressure increases and left atrial hypertrophy and dilation occur.  Consequently, pulmonary venous, pulmonary arterial and right heart pressures also increase.  The increase in pulmonary capillary pressure is followed by the development of pulmonary oedema, particularly when the rhythm deteriorates to atrial fibrillation with tachycardia and loss of coordinated atrial contraction.  This is partially prevented by alveolar and capillary thickening and pulmonary arterial vasoconstriction (reactive pulmonary hypertension).  Pulmonary hypertension leads to right ventricular hypertrophy, dilation and failure, with subsequent tricuspid regurgitation.  Symptoms  Usually, there are no symptoms until the valve orifice is moderately stenosed (area