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Heart valve
disease
Liu Chao,MD
Anatomy of heart
Anatomy of heart valve
The heart has two
halves, a left and a
right, each with two
chambers - the atrium
and the ventricle.
Between the chambers
are the heart valves
which ensure the
blood runs only in one
direction.
Anatomy of heart
There are also
heart valves
situated between
the ventricles and
the major arteries -
the aorta and
pulmonary artery -
where they have
the same function.
Classification of heart valve
disease?
Narrowed valves
Leaking valves
Narrowed valves
These may be due to:
congenital abnormality
Rarely congenital
RV Pressure
Overload
RVH LV Filling
RV Failure
What are the symptoms?
Most people with mitral stenosis
have no symptoms. When symptoms
do happen, they may get worse with
exercise or any activity that
increases your heart rate. These may
include
What are the symptoms?
Dyspnea on exertion, orthopnea, paroxysmal
nocturnal dyspnea
Coughing, hemoptsis, pinkish, blood-tinged
sputum.
Fatigue.
Chest pain that gets worse with activity and goes
away with rest.
Frequent respiratory infections such as
bronchitis.
Heart palpitations (the feeling that the heart has
skipped a beat).
Swelling (edema) of the feet and ankles.
A hoarse or husky-sounding voice.
What is the sign?
Thin and frail
Atrial fibrillation
Apical diastolic rumble murmur, an
increased first sound, an opening
snap
Diagnostic consideration
Clinical manifestation
Chest radiography
EKG
Echocardiography
Chest X-ray
Enlargement of the left atrium (double contour )
Kerley’s line (enlarged pulmonary lymphatics)
Distention of the pulmonary arteries and viens
“Straight” left border of the heart (the enlargement of
atrium and pulmonary artery obliterates the normal
concavity between the aorta and ventricle)
Mitral Stenosis: EKG
LAE
RVH
Premature contractions
Atrial flutter and/or fibrillation
↑ freq. in pts with mod-severe MS for several
years
A fib develops in ≈ 30% to 40% of pts
w/symptoms
Mitral Stenosis: Role of
Echocardiography
Diagnosis of Mitral Stenosis
Assessment of hemodynamic severity
mean gradient, mitral valve area, pulmonary artery
pressure
Assessment of right ventricular size and function.
Assessment of valve morphology to determine
Balloon valvuloplasty
Effective long term improvement
Mitral Stenosis:Therapy
Surgical
Mitral commissurotomy
Mitral Valve Replacement
Mechanical
Bioprosthetic
Cardiopulmonary bypass
Mitral commissurotomy
Mitral valve replacement
FDA-approved
mechanical mitral
valves. (A) Starr-
Edwards ball-and-
cage. (B)
Medtronic-Hall
tilting-disk. (C)
Omnicarbon
tilting-disk. (D) St.
Jude Medical
bifleaflet.
Mitral valve replacement
FDA-approved
mechanical
mitral valves. (E)
Carbomedics
bileaflet. (F) ATS
bileaflet. (G) ON-
X bileaflet.
Mitral valve replacement
FIGURE 38-3 FDA-
approved bioprosthetic
mitral valves. (A)
Hancock II porcine
heterograft. (B)
Carpentier-Edwards
standard porcine
heterograft. (C) Mosaic
porcine heterograft. (D)
Carpentier-Edwards
pericardial bovine
heterograft.
Operative procedure
(A) An ellipse is removed from
the posterior leaflet, and a flap
is cut form the central portion of
the anterior leaflet. The anterior
flap is flipped to the posterior
annulus and tacked to the
caudad edge of the posterior
leaflet and the posterior
annulus. Sutures anchoring the
prosthesis include the annulus
and anterior and posterior
leaflet remnants to which
chordae are attached. (B) The
anterior leaflet is partially
excised, and remnants are
"furled" to the annulus by
sutures used to insert the
prosthesis.
Suturing techniques for
prosthetic mitral valve
implantation.
Subannular sutures
placed from ventricle to
atrium for bioprosthetic
or Starr-Edwards
valves. Everting (supra-
annular) sutures placed
from atrium to ventricle
for bileaflet or tilting-
disk valves.
Recommendations for Mitral
Valve Repair for Mitral
Stenosis
ACC/AHA Class I
Patients with NYHA functional Class III-IV symptoms, moderate
or severe MS (mitral valve area <1.5 cm 2 ),*and valve
morphology favorable for replacement if percutaneous mitral
balloon valvotomy is not available
Patients with NYHA functional Class III-IV symptoms, moderate
or severe MS (mitral valve area <1.5 cm 2 ),*and valve
morphology favorable for replacement if a left atrial thrombus
is present despite anticoagulation
Patients with NYHA functional Class III-IV symptoms, moderate
or severe MS (mitral valve area <1.5 cm 2 ),* and a non-pliable
or calcified valve with the decision to proceed with either
repair or replacement made at the time of the operation.
Recommendations for Mitral
Valve Repair for Mitral
Stenosis
ACC/AHA Class IIB
Patients in NYHA functional Class I, moderate or
severe MS (mitral valve area <1.5 cm 2 ),* and
valve morphology favorable for repair who have
had recurrent episodes of embolic events on
adequate anticoagulation.
ACC/AHA Class III
Patients with NYHA functional Class I-IV
symptoms and mild MS.
*The committee recognizes that there may be a variability in the
measurement of mitral valve area and that the mean trans-mitral
gradient, pulmonary artery wedge pressure, and pulmonary artery
pressure at rest or during exercise should also be considered.
Fig. 1.1:
Dr. C. Walton Lillehei (opposite page), working
at the University of Minnesota, developed a
novel technique of cardiopulmonary bypass
called cross circulation, in which the circulation
of one person is used to support that of another
during an open-heart operation. It was used
successfully in sick children.