Deposition of aramide trihexoside thickens

Mitral Stenosis and decreases mobility of mitral leaflets

o Hurlers Syndrome
Deposition of mucopolysaccharide thickens
Rheumatic disease causes mitral stenosis in 99.8% of cases
and decreases mobility of mitral leaflets
Acute rheumatic fever (ARF) pancarditis
o Whipples Disease
o Mitral valve most commonly involved valve
Same as gut lesions in mitral leaflets
o Followed by mitral and aortic together
o LA Myxoma
o Then by aortic alone
Most common form of primary cardiac tumor
Acute phase cardiomegaly
86% of myxomas are found in left atrium
o Mitral regurgitation is valvular lesion of ARF
90% of myxomas are solitary
o As acute phase subsides, fibrosis alters leaflet or cusp
Usually occur around fossa ovalis
structure
X-Ray Findings of MS
o Results in cuspal or leaflet thickening
o Cardiac Findings
along valvular margins of closure
Usually normal or slightly enlarged cardio-
Mitral Valve Calcification
thoracic ratio
o Calcium usually deposited in clumps on valve leaflets
Straightening of left heart border
o Heavier calcific deposits in men than women
Convexity of left heart border 2 to enlarged
o Calcification of mitral annulus does not signify presence
atrial appendage--only
of mitral valvedisease
in rheumatic heart disease
Occurs in older women
o X-Ray Findings of MS
Mitral orifice becomes smaller two circulatory changes
Cardiac Findings
o To maintain LV filling across narrowed valve, left atrial
Small aortic knob from decreased
pressure goes up
cardiac output
o Blood flow across mitral valve is decreased which
Double density of left atrial enlargement
decreases cardiac output
Rarely, right atrial enlargement from tricuspid
Mitral Valve Areas
insufficiency
o Normal mitral valve orifice 4-6 sq cm in adults
o When reduced to <2 sq cm, LA pressure increases
Frontal radiograph of the chest shows a convexity in the region of the
o Gradient across mitral valve is hallmark
left atrium indicating left atrial enlargement from mitral stenosis.
of mitral stenosis
The patient was swallowing barium at the time of the exposure.
About 20 mm Hg in mitral stenosis
MS and MR
o Rheumatic mitral stenosis occurs with varying degrees X-Ray Findings of MS-Calcifications
of mitral regurgitation o Calcification of mitral valve--not annulus--seen best on
o When MS is severe, MR is relatively unimportant lateral film at fluoroscopy
Effect of MS on Heart o Rarely, calcification of the left atrial wall 2 fibrosis from
o Left atrium hypertrophies and dilates 2 pressure and long-standing disease
volume load o Rarely, calcification of pulmonary arteries from PAH
o Atrial fibrillation and mural thrombosis follow X-Ray Findings of MS-Pulmonary Findings
o Left ventricle is protected by stenotic valve o Cephalization
Usually normal in size and contour o Elevation of left mainstem bronchus (especially if 90 to
Effect of MS on Lungs trachea)
o Increased pulmonary venous and capillary pressure o With severe, chronic disease enlargement of the main
o Chronic edema of alveolar walls fibrosis pulmonary artery from pulmonary arterial
o Pulmonary hemosiderin is deposited in lungs hypertension
o Pulmonary ossification may occur Mitral Stenosis-Echocardiographic Findings
Effect of MS on Lungs o In 90%, M-mode study will demonstrate flattening of E-F
o Pulmonary arterial hypertension develops slope
o First passively o Decreased diastolic excursions of mitral leaflets
o Then 2 muscular hypertrophy and hyperplasia o Concordant anterior movement of anterior and posterior
increased pulmonary vascular resistance leaflets during systole
Effect of MS on Right Ventricle Mitral Stenosis-Echocardiographic Findings
o RV hypertrophies in response to increased afterload o If left atrium > 5cm, increased incidence of
o Eventually RV fails and dilates o Atrial fibrillation
o Causes dilation of tricuspid annulus tricuspid o Left atrial thrombus
regurgitation o Systemic embolization
Mitral Stenosis-Other Causes Mitral Stenosis-Angiographic Findings
o Congenital Mitral Stenosis o Ventriculography in 30 to 40 RAO projection usually
Exists as isolated abnormality 25% of time used
Coexists with VSD 30% of time o Severity of lesion determined hemodynamically by
Coexists with another form of left ventricular simultaneously measuring
outflow obstruction 40% of time o Pulmonary capillary wedge pressure
SHONES Syndrome o Left ventricular inflow tract pressure and
Shones Syndrome o Cardiac output
o Parachute mitral valve Mitral Stenosis-Angiographic Findings
o Supravalvular mitral rin o Calcified, hypokinetic and domed mitral leaflets
g o Enlargement of left atrium
o Subaortic stenosis o Left ventricle is small with a reduced ejection fraction
o Coarctation of aorta Mitral Stenosis-Angiographic Findings
o Infective Endocarditis o Mitral valve leaflets appear thickened and nodular and
Large vegetations occurring on previously may appear to attach directly to the papillary muscle
normal mitral valve may produce MS o Scarring and retraction of the chorda tendina
o Carcinoid Syndrome
Carcinoid of lung allows for prolonged Mitral Stenosis. The left atrium is enlarged, displacing the left atrial
exposure of mitral valve to serotonin appendage outward (red arrow). On the right side of the heart, a
May result in stiff, stenotic mitral valve "double density" consisting of overlapping of the left atrium (black
o Fabrys Disease arrow) and right atrium (white arrow) is seen. The left main bronchus
is elevated by the enlarged left atrium pushing it upwards (blue
arrow).