MITRAL VALVE DISEASES MITRAL VALVE DISEASES 1 Mitral

MITRAL VALVE DISEASES

MITRAL VALVE DISEASES 1. Mitral valve stenosis. 2. Mitral valve regurge. 3. Mitral valve prolapse.

MITRAL VALVE STENOSIS Definition: Is the obstruction to diastolic flow of blood through mitral valve.

CAUSES n Rheumatic heart disease n Female > Male n Congenital heart disease 50% 9: 1 1%

SYMPTOMS: 1. Dysponea 2. Orthopnea 3. P. N. D. 80%

4. Hemoptysis 5. Palpitations 6. Systemic Embolism

7. Systemic congestive symptoms 2 nd to increased pul. Art. Pressure Ø Congested Neck Veins Ø Rt. Hypochondrial pain Ø Swelling of abdomen and ankel

SIGNS: Ø Molar flush area Ø Pulse is normal or small v. Ø B. P is normal Ø Palpable first HS (Tapping Apex)

ØLoud first heart sound ØOpening snap. ØMid-Diastolic rumbling murmur. ØPresystolic accentuation. ØPulmonary signs. ØSigns in presence of pulmonary hypertension.

E C G: Biphasic P-wave atrial activation time is increased

C X R: • Dil. LA • Dil. Pul. Art. • Pul. Congestion • Pul. Oedema

ECHO: Ø Thickend MVL Ø Decrease Mit V. opening Ø MV Area Less than 4 cm 2 § 2 - 4 cm 2 Mild MS § 1 -2 cm 2 moderate MS § < cm 2 stvere MS Ø Dilated left atrium.

DIFF. DIAGNOSIS 1. Cary comb murmur 2. Lt. Atrial mexoma 3. Cortriatrium 4. Austen-Flint murmur

COMPLICATIONS: 1. AF 2. Pulmonary hypertension, RVF 3. Bronchitis 4. Pulmonary infraction 5. Syst. embolism

TREATMENT: Ø MEDICAL +++ ØSURGICAL+++

HAEMODYNAMICALLY INSIGIFICANT MITRAL INCOMPETENCE Click murmur syndrome or MVP or Barlow’s Dis.

SYMPTOMS: ØAsymptomatic ØMild chest pain ØPalpitations ØMild dyspnoea

ECHO: Prolapse of Ant. Or Post. Mitral valve leaflet.

CXR: ØNormal.

ECG: ØNon- Specific.

SIGNS: ØNormal pluse Volume. ØNormal BP. ØLate systolic murmur at Apex. ØLate systolic click.

HAEMODYNAMICALLY SIGNIFICANT MITRAL INCOMPETENCE

MITRAL INCOMPETENCE CAUSES: 1 - ACUTE endocrditis Myoc. Infarction

2 - CHRONIC: Ø Rheumatic fever Ø Congenital heart disease ASD marfan’s MVP Coronary A-V fistula 50%

Ø M. V. ring calcification ØMyxomatous degeneration. ØTraumatic heart disease

ACUTE LESIONS: Symptoms: dyspnoea * palpitations *

SIGNS: Absent 1 st HS ØPan syst. Murmur at mitral area. Øsyst. thrill in 50% of cases.

ECG: • Lt V. enlargement • Lt A. enlargement

CXR: Enlarged cardiac shadow pul. Congestion

ECHO: Enlarged LV Enlarged LA

COMPLICATIONS: Ø Infect. Endocarditis ØAcute disruption of mitral valve ØVent. arrythmia

COMPLICATIONS: ØSystemic embolism ØEndocarditis

TREATMENT § Prophylactic antibiotic of complications. § Surgical MV repair § Surgical MV replacement

Mixed MS + MR SYMPTOMS: Ødyspnoea ØPalpitations ØSyst. Embolism ØPressure from large LA

COMPLICATIONS: AF Rheumatic myocarditis Endocarditis Syst. Embolism

TREATMENT: Ø MV Repair Ø MV Replacement