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 Rheumatic heart disease 50% Female < Male 9 : 1 Congenital heart disease 1%

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

4. Hemoptysis 5. Palpitations 6. Systemic Embolism

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

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

 Loud first heart sound  Opening snap.  Mid-Diastolic rumbling murmur.  Presystolic accentuation.  Pulmonary signs.  Signs 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:  Thickend MVL  Decrease Mit V. opening  MV Area Less than 4 cm 2  Dilated left atrium.  2- 4 cm 2 Mild MS  1-2 cm 2 moderate MS  > cm 2 stvere MS

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:   MEDICAL +++  SURGICAL+++

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

SYMPTOMS:  Asymptomatic  Mild chest pain  Palpitations  Mild dyspnoea

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

 Normal. CXR:

 Non- Specific. ECG:

SIGNS:  Normal pluse Volume.  Normal BP.  Late systolic murmur at Apex.  Late systolic click.

HAEMODYNAMICALLY SIGNIFICANT MITRAL INCOMPETENCE

MITRAL INCOMPETENCE endocrditis Myoc. Infarction CAUSES:- 1- ACUTE

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

  M.V. ring calcification  Myxomatous degeneration.  Traumatic heart disease

ACUTE LESIONS: Symptoms: * dyspnoea * palpitations

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

ECG: Lt V. enlargement Lt A. enlargement

Enlarged cardiac shadow pul. Congestion CXR:

Enlarged LV Enlarged LA ECHO:

COMPLICATIONS:   Infect. Endocarditis  Acute disruption of mitral valve  Vent. arrythmia

COMPLICATIONS:  Systemic embolism  Endocarditis

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

Mixed MS + MR  dyspnoea  Palpitations  Syst. Embolism  Pressure from large LA SYMPTOMS:

AF Rheumatic myocarditis Endocarditis Syst. Embolism COMPLICATIONS:

TREATMENT:   MV Repair  MV Replacement